A comparison of clinical tests for the detection of vibration perception threshold in a diabetic population

Abstract

Background: Diabetic Peripheral Neuropathy (DPN) is a complication which contributes to morbidity in diabetes mellitus. Evidence indicates that early detection of DPN results in fewer foot ulcers and amputations. Aim: The aim of this study was to compare different screening tests in the detection of Diabetic Peripheral Neuropathy in primary care setting. Research design and method: A prospective non-experimental comparative multi-centre cross sectional study was conducted in various Primary Health Centres. One hundred participants living with Type 2 diabetes for at least 10 years were recruited using a convenience sampling method. The Vibratip, 128Hz Tuning Fork and Neurothesiometer were compared for sensitivity and specificity in the detection of vibration perception. Results: This study showed different results of DPN screening tests, even in the same group of participants. This study has shown that the percentage of participants that did not perceive vibrations was highest when using the VibraTip (28.5%). This was followed by the neurothesiometer (21%) and the 128 Hz Tuning Fork (12%), p<0.001. Conclusion: Correct diagnosis and treatment of neuropathy in patients with diabetes is crucial. This study demonstrates that some instruments are more sensitive to vibration perception than others. We recommend that different modalities should be used in patients with diabetes to test for DPN and when results do not concur, further neurological evaluation should be performed. This would significantly reduce the proportion of patients with diabetes who would be falsely identified as having no peripheral neuropathy and subsequently denied the benefit of beneficial and effective secondary risk factor control.