Publication | Closed Access
The Rochester Diabetic Neuropathy Study
305
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1991
Year
Diabetes ManagementMuscle Action PotentialsNeurological DisorderTest ReproducibilityDiabetesDiabetic NeuropathyNeuropathic PainRehabilitationNeurologyDiabetes MellitusMultiple SclerosisNeuropathologyMedicineCross-sectional SurveyPhysical Therapy
The study evaluated 380 diabetic patients to assess associations among neuropathy tests, determine the usefulness of various tests for diagnosing and staging polyneuropathy, establish minimal diagnostic criteria, and examine differences in test results across neuropathy stages. The authors proposed minimal diagnostic criteria requiring at least two abnormal evaluations among symptoms, deficits, nerve conduction, quantitative sensory examination, and quantitative autonomic examination, with at least one abnormality in nerve conduction or autonomic testing. Nerve conduction and quantitative autonomic examination were the most sensitive for detecting subclinical neuropathy, while symptom and disability scores, quantitative sensory thresholds, and summed compound muscle action potentials best assessed severity, and inability to walk on heels effectively distinguished mild from more severe neuropathy.
We evaluated the initial assessments of the 380 diabetic patients with and without polyneuropathy in the Rochester Diabetic Neuropathy Study for (1) associations among neuropathy test results, (2) usefulness of different tests for diagnosing and staging polyneuropathy, (3) appropriateness of different minimal criteria for the diagnosis of polyneuropathy, and (4) significant differences in test results with increasing stage of polyneuropathy. Nerve conduction ([NC]; abnormality in two or more nerves) and quantitative autonomic examination ([QAE]; decreased heartbeat response to deep breathing [DB] or the Valsalva maneuver [VAL]) were the most sensitive and objective and were especially suitable for detection of subclinical neuropathy. We propose the following minimal criteria for the diagnosis of diabetic polyneuropathy: ⩾ abnormal evaluations (from among neuropathic symptoms, neuropathic deficits, NC, quantitative sensory examination [QSE], and QAE) with one of the two being abnormality of NC or QAE (DB or VAL). Neuropathy Symptom Score, Neuropathy Disability Score, QSE (vibratory or cooling detection threshold), and summated compound muscle action potential of ulnar, peroneal, and tibial nerves were best for judging severity. Inability to walk on heels provided a discrete separation of diabetic patients into those with mild and those with more severe neuropathy—a separation helpful in staging.