Diabetic peripheral neuropathy: how reliable is a homemade 1-g monofilament for screening? A case-control study of sensitivity, specificity, and comparison with standardized sensory modalities

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Authors: Matthew E. Bourcier, Jagdeesh Ullal, Henri K. Parson, Charlotte B. Dublin, Crystal A.G. Witherspoon and Sheila A. Ward
Date: June 2006
From: Journal of Family Practice(Vol. 55, Issue 6)
Publisher: Frontline Medical Communications Inc.
Document Type: Disease/Disorder overview
Length: 1,681 words

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Practice recommendations

* Use fishing line cut to different lengths (4 cm = 10 g; 8 cm = 1 g) as substitutes for monofilaments to assist in the diagnosis of diabetic neuropathy. This test is highly specific for neuropathy; using longer lengths of line increases sensitivity.

* Physicians and healthcare providers can use this quick, inexpensive tool for screening neuropathy. Patients can be empowered inexpensively to examine their own feet and reduce the likelihood of developing foot ulcers or amputations.

If there were a less expensive means of reliably performing a standard clinical test in diabetes care, would you want to know about it? If your answer is yes, then the results of this study should be of interest to you. What's more, your patients can be given the same test to perform at home.

Patients with diabetes have a 15- to 40-times greater risk of leg amputations than those without diabetes, due to loss of protective sensation, ulceration, infection, and gangrene. (1-6) Screening for loss of sensation helps prevent foot ulcerations and amputations.

According to the 1988 San Antonio ADA/AAN consensus, (7) a diagnosis of diabetic neuropathy (revised in 1992) (8) requires that 2 of 4 criteria be met: signs and symptoms, nerve conduction abnormalities, quantitative sensory test (QST) abnormalities, or autonomic test abnormalities. Monofilament testing, part of the QST, can detect loss of pressure sensation on the foot. The 10-g monofilament predicts foot ulcers, (9-11) and the 1-g tests sensitivity. (12) The reproducibility and predictive value of monofilaments in identifying diabetes patients at risk for serious limb complications have led the International Diabetes Federation and the World Health Organization to recommend their use. (13)

Our aim was to demonstrate the utility of 10-g and 1-g monofilaments constructed from fishing line in screening for diabetes neuropathy compared with other QST modalities, including the entire set of monofilaments, in a forced-choice algorithm. We also wanted to show that physicians and patients alike can use this simple, disposable, single-use method for detecting neuropathy.

* Methods

We studied 871 subjects (579 normal controls and 292 patients with diagnosed peripheral neuropathy). The study consisted of a 15-item questionnaire that surveyed age, height, weight, race, and diabetes-related issues. We measured random glucose levels with a glucometer to rule out undisclosed hypoglycemia among controls, and performed vibration detection thresholds (VDT) as another confirmatory neuropathy test (values >15 V).

Disposable monofilaments were constructed in our laboratory using commercially available 25-lb "South Bend" brand high-knot-strength fishing line No. M142.5 (South Bend, Inc, North Brook, Ill), which measured 0.020 inches (500...

Source Citation

Source Citation
Bourcier, Matthew E., et al. "Diabetic peripheral neuropathy: how reliable is a homemade 1-g monofilament for screening? A case-control study of sensitivity, specificity, and comparison with standardized sensory modalities." Journal of Family Practice, vol. 55, no. 6, 2006, p. 505+. Accessed 10 May 2021.
  

Gale Document Number: GALE|A147391286