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Diabetic Neuropathy: Sensitivity and Specificity

Introduction: None written.

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Tags: Metabolic Neurologic Tag this Diagnosis.

Prevalence

Population / Calculator	Prevalence	Comments / Study / Link
Diabetics 60-74 years old	40%	(32-50%) Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
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The sensitivity and specificity of findings for Diabetic Neuropathy are listed below. See the left navigation bar to change the display.

Pre-Test Probability (Prevalence): %.	Post-Test Probability (Predictive Value): %.	Switch to display mode.
Note that calculating probabilities from more than one** finding is inherently inaccurate because findings are not independent. (For example, using two positive findings that share a common pathogenesis is likely to overestimate the true probability.)

Sensitive Findings
Finding	Result	Sensitivity	Specificity
[ + ] Michigan Diabetes Neuropathy Score	+ 0 -	94%	78%
The MDNS is a point scale ranging from 0 to 46 (higher score reflecting more severe peripheral neuropathy), and it correlates well with more extensive neuropathy staging scales. The MDNS includes muscle stretch reflexes at the biceps, triceps, patella, and Achilles, pinprick sensation at the great toe, ability to perceive the touch of a 10-g monofilament and a 128Hz tuning fork at the great toe, strength of hand dorsal interossei, great toe extension, and ankle dorsiflexion. (Normal < 10 points) Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
[ + ] Proprioception	+ 0 -	88%	69%
at great toe Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324

Poorly Diagnostic Findings
Finding	Result	Sensitivity	Specificity
[ + ] Vibration sensation	+ 0 -	75%	84%
at ankle. Note that this study also looked at the great toe and obtained values of 96% sensitivity with 75% specificity. Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324
[ + ] Unipedal Stance Testing	+ 0 -	81%	56%
For UPS, subjects stood with their weight evenly distributed on both feet, which were shoulder-width apart, and arms held comfortably at the side. Subjects were then asked to balance on the foot of their choice for as long as possible to a maximum of 30 seconds. Failure occurred when the stance foot shifted in any way or the nonstance foot touched the ground. This procedure was repeated 3 times, and the number of seconds the subject was able to balance on 1 foot was recorded for each trial. (Normal >= 10s) Study: Arch Phys Med Rehabil. 2002 Nov;83(11):1553-8. PMID: 12422324