Comparison of different screening tests for detecting diabetic foot neuropathy

Regarding the major role of sensory neuropathy in diabetic foot ulcers, the use of an appropriate screening test for early detection of this neuropathy has a crucial role in the management of diabetic foot disorders. As there were no previous studies that performed all screening tests in the same group of patients, we performed all tests in a single group of diabetic patients and compared them to find out the possible differences between the results.

A total of 142 diabetic outpatients at Shariati Teaching Hospital were chosen by systematic randomized selection. Different screening tests for detecting neuropathy in diabetic foot such as symptom and sign scores, Michigan Neuropathy Disability Score (MNDS), and testing by a monofilament were performed for each patient.

According to the neuropathy symptom score, 54.9% of the patients were neuropathic, their score was higher than 5, and by neuropathy sign score, 10.1% were neuropathic with a score higher than 6. Regarding MNDS, 42.7% of the subjects were neuropathic, with a score higher than 3. Finally, 23.9% were unable to sense at least one point in the monofilament examination.

There were obvious differences between the results of different methods in our study. However, there were significant correlations between them, except between sign and symptom score methods. For determining the most reliable screening test, further studies are needed to compare these methods with a gold standard test and reveal the specificity and sensitivity of these tests.