'Numbness of the feet' is a poor indicator for polyneuropathy in Type 2 diabetic patients

Aims To identify neuropathic sensory symptoms associated with a clinical ne urological examination (CNE) and to investigate whether these symptoms coul d be used as a diagnostic or screening tool for diabetic polyneuropathy in general practice. Methods Five hundred and eighty-eight patients with Type 2 diabetes, recrui ted from 26 general practices in the Netherlands, underwent a CNE and compl eted a diabetes symptom checklist that included 10 items on neuropathic sen sory symptoms. Linear regression analyses were performed to assess the asso ciation between neuropathic symptoms and CNE. Receiver operating characteri stic (ROC) curves were created to assess the diagnostic properties of neuro pathic symptoms. Results In this population, with a mean age of 66.8 years, 32% were identif ied with diabetic polyneuropathy according to the CNE. Variables that showe d the strongest association with CNE score were age (beta = 0.41), symptoms of sensory alteration (beta = 0.27), and the item 'numbness of the feet' ( beta = 0.35) in particular. ROC curves showed that prediction of diabetic p olyneuropathy from these symptoms was unsatisfying. The sensitivity and spe cificity of daily symptoms of 'numbness of the feet' were 28% and 93%, resp ectively, in patients < 68 years, and 22% and 92%, respectively, in patient s greater than or equal to 68 years. Conclusions Identification of neuropathic sensory symptoms is not useful as a diagnostic or even a screening tool in the assessment of diabetic neurop athy in daily practice. Therefore, the results reported in this paper manda te an annual foot examination by the general practitioner.