Validation of Bedside Methods in Evaluation of Diabetic Peripheral Neuropathy‪.‬

The number of patients with diabetes mellitus is increasing by epidemic proportions in the world, particularly in India. Lower extremity disease, including peripheral neuropathy, foot ulceration, peripheral arterial disease, or lower extremity amputation, is twice as common in diabetic persons compared with non diabetic persons and it affects 30 per cent of diabetic persons who are older than 40 yr (1). In persons with diabetes mellitus, the annual population-based incidence of foot ulcer ranges from 1.0 to 4.1 per cent and the prevalence ranges from 4 to 10 per cent, which suggests that the lifetime incidence may be as high as 25 per cent (1). Screening and early identification of neuropathy offer a crucial opportunity for the patient with diabetes to actively modulate the course of suboptimal glycaemic control to currently recommended targets, and to implement improved foot care before the onset of significant morbidity. Clinical trial evidence for the efficacy of screening strategies have demonstrated reduced incidence of amputation and ulceration and screening for neuropathy is recommended in clinical practice guidelines (2). Most of the available modalities have been evaluated in developed countries where foot care practices are widely followed. Contrary to it, in developing countries barefoot walking is still prevalent and foot care practices are hardly followed (3), which can result in alteration in cutaneous morphology. This may influence the outcome of commonly used tools to identify neuropathy like the Diabetic Neuropathy Symptom (DNS) Score, 10-g Semmes-Weinstein monofilament, vibration testing by 128 Hz tuning fork, ankle reflex and the Diabetic Neuropathy Examination (DNE) score. Therefore, this study was planned to evaluate the usefulness of the above modalities with the standard well validated screening method of measuring vibration perception threshold (VPT) with a biothesiometer in a population where foot care practices are scantly followed.