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Early recognition of diabetic neuropathy: evaluation of a simple outpatient procedure using thermal perception
V Viswanathan1, C Snehalatha, R Seena
1Diabetes Research Centre, Madras, India. dr_vijay@vsnl.com
Objective:
To determine the effectiveness of Tip-therm, a temperature discriminator, in making an early diagnosis of distal symmetrical polyneuropathy in diabetic patients and to compare its effectiveness with the Semmes-Weinstein monofilament and biothesiometry, which are established methods of diagnosing neuropathy in diabetic patients.
Patients And Methods:
From the diabetic subjects who came to the hospital for review, 910 consecutive cases were selected. All were tested with the Semmes-Weinstein monofilament (10 g monofilament) and biothesiometry and also by using the Tip-therm for comparison.
Results:
Out of the 241 patients who had no sensation to the monofilament only four (1.7%) felt Tip-therm whereas 237 (98.3%) patients could not feel Tip-therm. Among 298 patients diagnosed as having neuropathy by biothesiometry, only eight (2.7%) patients exhibited sensation with Tip-therm while 290 (97.3%) patients could not feel it.
Conclusion:
A simple device, Tip-therm, which tests for temperature discrimination, was compared with two validated methods for detection of neuropathy-a monofilament and biothesiometry. Tip-therm appears to be an inexpensive, highly sensitive, and specific device for detection of diabetic neuropathy when compared with biothesiometry and a monofilament.