Variations in the Bedside Methods of Evaluating Diabetic Peripheral Neuropathy among Patients with Type 2 Diabetes. A Challenge for Primary Health Care Physicians in Trinidad a High Prevalence Setting for Type 2 Diabetes

摘要

Objective: The purpose of this study is to compare four measurements used in the diagnosis of DN, (1) symptom scoring, (2) physical examination scoring, (3) Semmes Weinstein monofilament testing, and (4) vibration sensation among patients with T2DM attending primary care facilities in North Trinidad. In addition, the study will demonstrate discrepancies between these four methods as well as estimate the prevalence of DN. Subjects and Methods: A cross-sectional survey of 14 primary care facilities chosen randomly in North Trinidad was conducted. Of the 292 patients that were screened for entry into our study, 276 met the inclusion criteria. . Using four standard clinical methods ie Symptom Scoring, Physical Examination, Monofilament testing and Vibration Perception the proportion of patient with neuropathy was measured and compared. Results: The mean age of the sample population was 60.8 SD ± 11.1 with the average duration of T2DM being 10.2 SD ± 8.4 years. Additionally, there were more females than males with a female to male ratio of 2.3:1. The proportion of participants testing positive for neuropathy by Symptom Scoring, Physical Examination, Monofilament testing and Vibration Perception was 82.6%, 54%, 42.4% and 25.4% respectively. Conclusion: In conclusion the diagnosis of peripheral neuropathy can be made only after a careful clinical examination with more than 1 test, as recommended by the American Diabetes Association. However monofilament testing may in a primary care setting may not be accurate and relevant.