Evaluation of peripheral neuropathy in patients with type 1 diabetes mellitus by bedside scoring procedure|
Karamifar, H; Mooadab, MH; Karamizadeh, Z & Amirhakimi, GH
Background: Foot ulceration and lower limb amputation are still common complications of Diabetes mellitus (DM). Diabetic foot problems account for more hospitalization days than any other diabetic problem. The main etiologic factors are diabetic neuropathy and peripheral vascular disease. An easy, simple to use and low cost method for screening of diabetic peripheral neuropathy will be very useful.
Methods: From May 2003 to May 2004, all diabetic patients (type 1) referred to endocrine clinic of Namazi Hospital were evaluated for diabetic peripheral neuropathy (DPN), using the bedside scoring procedure. A score of 3-5 indicated mild, 6-8 moderate, and 9- 10 severe DPN. The perception of vibration, temperature, pinprick and ankle reflex was examined. Tuning fork (128 Hz), neuropen, cold and warm water and reflex hammer were used for evaluation.
Findings: In this study we evaluated 80 patients (34 male and 46 female) with type 1 DM, with the age range of 6-31 years (Mean± SD 18.16± 5.22 yr). The overall prevalence of DPN was 13.75%: mild in 7.5%, moderate in 5% and severe in 1.25% of the patients. The most common physical finding was the absence of ankle reflex. Patients were divided into 2 groups based on the presence of DPN. The prevalence of DPN was significantly associated with age, duration of DM and BMI (P<0.05). There was no significant correlation with sex, HbAlc, puberty, parental consanguinity and family history of DM.
Conclusions: Bedside scoring procedure is a simple, low cost and easy method for screening of DPN in patients with type 1 DM in outpatient clinic. Examination of ankle reflex is very important. It is concluded that the diabetic patients need better follow-up and more education.
Diabetes, Peripheral neuropathy, Tuning fork, Ankle reflex, Neuropen