SIMPLIFIED DIAGNOSTIC-CRITERIA FOR DIABETIC DISTAL POLYNEUROPATHY - PRELIMINARY DATA OF A MULTICENTER STUDY IN THE CAMPANIA REGION

The diagnostic procedures recommended for diabetic neuropathy are rath er complex and there is the risk that they may be applied only in high ly specialized research centres and not in other more basic health ser vice centres that recruit large numbers of diabetic patients. This con sideration highlights the need for rapid and precise diagnostic proced ures for the screening and follow-up of diabetic patients, In this pap er we describe a simplified diagnostic protocol for distal polyneuropa thy (DP), which is the most common form of peripheral neuropathy assoc iated with diabetes. We performed an electroneurographic examination ( ENG) based on a five-nerve evaluation in 204 diabetic subjects, and to ok it as the standard. Its reproducibility preliminarily assessed with a test-retest evaluation was 100%. DP was found in 47 of the 204 diab etic patients on the basis of an alteration in at least two nerves. Ot her clinical parameters, including a questionnaire on symptoms, a clin ical neurological examination (NE), and the vibration perception thres hold (VPT) were evaluated. The variability coefficient was not signifi cant for all clinical parameters in a selected group of diabetic patie nts (questionnaire= 21,2%, NE=5%, VPT=16.5%). The sensitivities and sp ecificities of the questionnaire, NE, and VPT in comparison with ENG w ere 87% and 60% for the questionnaire, 94% and 92% for NE, and 64% and 97% for VPT, respectively. Thus, the use of ENG permitted the recogni tion of DP in 14% of patients who were still asymptomatic. Finally, a four-nerve ENG was compared with the five-nerve procedure, and the con cordance between the two tests was 100%.