Natural history of peripheral neuropathy in patients with (non-)insulin dependent diabetes mellitus
Willem D. Rinkel, MD, PhD, Utrecht University Medical Center, Utrecht, Netherlands and J. Henk Coert, MD, PhD, Plastic-, Reconstructive- and Hand surgery, University Medical Center Utrecht, Utrecht, Netherlands
Background
There is little information on the natural history of pedal complaints and sensory loss as seen in diabetic peripheral neuropathies.
Methods
We studied Rotterdam Diabetic Foot (RDF) Study participants (n=416) at baseline and one to one and a half years later, for three times, as part of a prospective, observational study (the RDF Study). Symptoms and sensory status were assessed using the Michigan Neuropathy Screening Instrument and RDF Study Test Battery, which includes two-point discrimination, monofilament and vibratory testing, together with the assessment of the presence of compression neuropathies (using the Tinel sign). We investigated the progression of polyneuropathy in a 5-year time frame, using one-way repeated measures ANOVA and general linear models.
Results
In five years, 183 patients completed the study. At baseline the prevalence of neuropathy (MNSI>3) was 42.3% (95%CI: 37.1 to 47.5), 5 years later 41.0% (95%: 33.9 to 48.1, p=NS). For 75 patients repeated measurements were available from the four assessments over time. In these patients, the mean baseline MNSI symptom score was 3.6 (SD: 2.8) and did not significantly change at final follow-up (mean score: 3.4 (SD: 2.8, p=NS). Vibratory sense deteriorated significantly over time at only one out of four test locations (left hallux: 4.2 (SD: 2.7) to 3.2 (SD: 3.2), p<0.001). Cutaneous thresholds at the halluces did not increase in this time frame (left: 2.2 g (SD: 5.8) to 2.2 g (SD: 7.7), p=NS; right: 1.8 g (SD: 5.5) to 2.2 g (SD: 7.2), p=NS).
Conclusions
In this observational cohort, the prevalence of neuropathy among patients with diabetes did not increase in a 5-year timeframe. Sensory symptoms at the feet remained stable in the window of observation, as were the majority of pedal sensory thresholds. Vibration sense deteriorated, which poses a risk for diabetic foot ulceration, postural disbalance and recurrent falls and should be actively investigated during the physical examination.
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