Screening Tests For Neuropathy In Diabetic Patients With Foot At Risk

Abstract

Background and objectives: Diabetes mellitus (DM) is one of the public health problems of the whole world. Prevalence of DM is increasing rapidly worldwide and it is reaching the epidemic proportions. Diabetes leads to many macro vascular complications like coronary artery diseases, peripheral vascular disease, stroke etc. And it also causes micro vascular complications leading to end organ damage like cardiomyopathy, nephropathy, retinopathy and neuropathy. This study is about selecting proper tools to identify tests for neuropathy in diabetic patients with “Foot at risk”. Methodology: Observational analytical study conducted among 40 patients with h/o diabetic foot ulcer (Group A) and 120 patients without h/o diabetic foot ulcer (Group B) with Diabetes Mellitus attending Surgery/Medicine OPD or admitted in Surgery/Medicine wards during the study peri od from Octob er 2017 to May 2019 were considered in the study. Data analy z ed using SPSS software version 16. The association between the DM and neuropathy was tested using Chi square test and Fisher’s exact test. p value <0.05 was considered as significant. Sensitivit y, specificity, positive predictive value, negative predictive value, % of false positive, % of false negative and accuracy of the screening test were calculated. Results: The mean age of the study participants in Group A was 59.25 ± 12.22years and that of Group B was 61.98 ± 10.65years. Illiteracy, co-morbidities like Hypertension, Dyslipidemia and Heart disease were associated with patients of Group A. As the duration of diabetes (>10years) increases the probability of foot ulceration was more. Probability of getting foot ulceration was more among patients with uncontrolled diabetes. DPN diagnosis by verbal questionnaire method showed the sensitivity of 87.5% & specificity of 91.67%. By Semmes- Weinstein 10G monofilament wire testing showed the sensitivity of 75% & specificity of 77.5% and by Biothesiometer showed the sensitivity of 72.5% and specificity of 86.67%. Conclusion: Annual screening of diabetic patients for diabetic neuropathy by verbal questionnaire method had the higher sensitivity and specificity, followed by Semmes- Weinstein 10G monofilament wire testing and Biothesiometer..