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. 2021 Nov-Dec;25(6):509-515.
doi: 10.4103/ijem.ijem_426_21. Epub 2022 Feb 17.

Standard Clinical Screening Tests, Sural Radial Amplitude Ratio and F Wave Latency Compared to Conventional Nerve Conduction Studies in the Assessment of Sensorimotor Polyneuropathy in Patients with Type 2 Diabetes Mellitus

Saraswathi Ramanathan  1 , Raji Thomas  1 , Asem Rangita Chanu  2 , Dukhabandu Naik  3 , Felix Jebasingh  4 , Ajit Sivadasan  5 , Nihal Thomas  4
Affiliations

Standard Clinical Screening Tests, Sural Radial Amplitude Ratio and F Wave Latency Compared to Conventional Nerve Conduction Studies in the Assessment of Sensorimotor Polyneuropathy in Patients with Type 2 Diabetes Mellitus

Saraswathi Ramanathan et al. Indian J Endocrinol Metab. 2021 Nov-Dec.

Abstract

Background and aims: The measuring tools used for assessment of neuropathy include various questionnaires, monofilament testing, Biothesiometry and the gold standard test, nerve conduction studies (NCS). This study aims to evaluate the diagnostic accuracies of Michigan Neuropathy Screening Instrument (MNSI), Biothesiometry, Semmes Weinstein Monofilament (SWMF), Sural Radial Amplitude Ratio (SRAR) and minimal F wave latency as compared to conventional NCS and arrive at a simple diagnostic algorithm for early detection of Diabetic Peripheral Neuropathy (DPN).

Methods: In a cross-sectional observational study on 48 Type 2 diabetes mellitus patients, MNSI, Biothesiometry, SWMF and NCS including F waves and SRAR were done and diagnostic accuracies (sensitivity, specificity, positive and negative predictive values) calculated taking NCS as gold standard.

Results: MNSI, Biothesiometry, SWMF, SRAR and minimal F wave latency had a sensitivity of 64.3%, 78.6%, 14.3%, 100% and 78.6% and specificity of 67.7%, 52.9%, 94.1%, 23.53% and 76.47% respectively, with reference to NCS. Based on combined sensitivities and specificities, we arrived at a simple algorithm for early diagnosis of DPN, which showed that DPN could either be diagnosed or ruled out in 75% of the patients by a combination of the Biothesiometry, SRAR and left lower limb minimal F wave latency results.

Conclusions: In the setting of an outpatient, multidisciplinary diabetic clinic, simple tests such as questionnaires, monofilament testing and biosthesiometer could be performed with greater ease while considering NCS as the gold standard. This algorithm, combining Biothesiometry, SRAR and left lower limb minimal F wave latency would be less time consuming and help in early diagnosis of DPN.

Keywords: Biothesiometry; F wave; diabetic peripheral neuropathy; nerve conduction studies; sural radial amplitude ratio.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
ROC curve for sural radial amplitude ratio (with NCS as gold standard)
Figure 2
Figure 2
ROC Curve for biothesiometer (with NCS as Gold Standard)
Figure 3
Figure 3
Flow chart showing simple outpatient based algorithm for early diagnosis of diabetic peripheral neuropathy
See this image and copyright information in PMC

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