Letter: The Necessity of the Simple Tests for Diabetic Peripheral Neuropathy in Type 2 Diabetes Mellitus Patients without Neuropathic Symptoms in Clinical Practice (Diabetes Metab J 2018;42:442-6)

Jun Hwa Hong
2018 Diabetes & Metabolism Journal  
Diabetic neuropathy is a serious complication of diabetic patients. Serial progression of diabetic neuropathy leads from initiation of foot ulcer, subsequent amputation of extremities to severe disability, poor quality of life, and economic burden. The prevalence of diabetic neuropathy with type 2 diabetes mellitus is associated with glycemic control state and duration from the diagnosis of diabetes [1]. However, even in prediabetes, the prevalence of diabetic neuropathy is higher than normal
more » ... igher than normal glucose control state. Although different for each investigator, Lee et al. [2] reported that the prevalence of neuropathy with prediabetes (49%) was similar with new-onset diabetes (50%) in a longitudinal cohort of Prospective Metabolism and Islet Cell Evaluation (PROMISE). Especially in diabetic patients with long duration, early detection of diabetic neuropathy difficult because they are frequently asymptomatic with elevated pain threshold [3] . One of the recommended standard treatments for diabetic neuropathy is pregabalin. The treatment with pregabalin for diabetic neuropathy was more effective in patients with short duration of diabetes [4] . Thus, early detection and early treatment of diabetic neuropathy is important to prevent further complication and deterioration of life quality. In this article entitled "The necessity of the simple tests for diabetic peripheral neuropathy in type 2 diabetes mellitus pa-tients without neuropathic symptoms in clinical practice, " Park et al. [5] investigated the detection ability of practical modalities to discriminate patients with diabetic neuropathy from type 2 diabetes mellitus patients with or without neuropathic symptoms. The combination of six modalities (pinprick test, tuning fork test, Semmes-Weinstein monofilament examination [SWME], ankle reflex, and two questionnaires of Michigan Neuropathy Screening Instrument [MNSI] and total symptom score) for detecting patients with diabetic neuropathy showed higher sensitivity (97.9% for patients with symptoms, 70.5% for patients without symptoms). However, it is limited by that there is no single gold standard test for detecting diabetic neuropathy. The 10-g SWME is known as a representative diagnostic tool for detecting diabetic neuropathy patients. However, the sensitivity of the monofilament test is very variable from 15% to 95%. According to the meta-analysis of the diagnostic accuracy of monofilament test, the sensitivity and specificity were 53% and 88%, respectively [6] . In children below 18 years old with type 1 diabetes mellitus, the accuracy of monofilament test was also variable from 19% to 73%. The sensitivity of tuning fork test was discouraging, 1% to 19% [7]. In this article by Park et al. [5], the abnormal results of SWME were relative low (18.8% with patients with symptoms, 5.7% with patients with symptoms). With the variable results of diagnostic tests, performing
doi:10.4093/dmj.2018.0238 fatcat:inhosaffwbesldejwgohlveocu