CLINICAL-TESTING IN DIABETIC PERIPHERAL NEUROPATHY

Diabetic polyneuropathy is a complex disease of progressive nerve fibe r loss. Initial screening and diagnosis in clinical practice usually d epend on assessment of subjective complaints. A need exists for object ive, simple, and reproducible assessment tools that can be readily use d in clinical practice. The importance of early diagnosis is highlight ed by the recent North American Diabetes Control and Complications Tri al where intensive insulin therapy reduced the risk of developing diab etic neuropathy by 61%. At the University of Michigan, we have develop ed an outpatient neuropathy program. Patients are given a questionnair e and a brief screening examination, designated the Neuropathy Screeni ng Instrument. Diabetic neuropathy is confirmed and staged in patients with a positive Neuropathy Screening Instrument, by a quantitative ne urologic examination and nerve conduction studies, designated the Diab etic Neuropathy Score. The Michigan program has been compared with wel l-established instruments and has been found to be sensitive and repro ducible for screening and diagnosis. We believe the program provides a valuable tool for the clinician in the practice setting and should al low diagnosis and intervention earlier in the course of diabetic neuro pathy.