Associations of nerve conduction study variables with clinical symptom scores in patients with type 2 diabetes

Joong Hyun Park; Jae Hyeon Park; Jong Chul Won

doi:10.14253/acn.2019.21.1.36

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Park, Park, and Won: Associations of nerve conduction study variables with clinical symptom scores in patients with type 2 diabetes

Original Article

Ann Clin Neurophysiol 2019;21(1):36-43.

Published online: 20 January 2019

DOI: https://doi.org/10.14253/acn.2019.21.1.36

Associations of nerve conduction study variables with clinical symptom scores in patients with type 2 diabetes

Joong Hyun Park¹, Jae Hyeon Park¹, Jong Chul Won^2,

¹Department of Neurology, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

²Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea

Correspondence to Jong Chul Won Department of Internal Medicine, Cardiovas-cular and Metabolic Disease Center, Sang-gye Paik Hospital, Inje University College of Medicine, 1342 Dongil-ro, Nowon-gu, Seoul 01757, Korea Tel: +82-2-950-8860 Fax: +82-2-2091–1464 E-mail: drwonjc@gmail.com

Received 12 November 2018 Revised 26 December 2018 Accepted 28 December 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background

Diabetic peripheral polyneuropathy (DPN) is associated with a variety of symptoms. Nerve conduction studies (NCSs) are considered to be the gold standard of nerve damage assessments, but these studies are often dissociated from the subjective symptoms observed in DPN patients. Thus, the aim of the present study was to investigate the correlations between NCS parameters and neuropathic symptoms quantified using the Michigan Neuropathy Screening Instrument (MNSI).

Methods

Patients with type 2 diabetes mellitus (T2DM) with or without symptoms of neu-ropathy were retrospectively enrolled. Demographic data, clinical laboratory data, MNSI score, and NCS results were collected for analysis; DPN was diagnosed based on the MNSI score (≥ 3.0) and abnormal NCS results. Pearson's correlation coefficients were used to evaluate the relationships between MNSI score and NCS variables.

Results

The final analyses included 198 patients (115 men and 83 women) with a mean age of 62.6 ± 12.7 years and a mean duration of diabetes of 12.7 ± 8.4 years. The mean MNSI score was 2.8 (range, 0.0–9.0), and 69 patients (34.8%) were diagnosed with DPN. The MNSI score was positively correlated with the median motor nerve latency and negatively correlated with the median motor, ulnar sensory, peroneal, tibial, and sural nerve conduction velocities (NCVs). When the patients were categorized into quartiles according to MNSI score, peroneal nerve conduction velocity was significantly lower in the second MNSI quartile than in the first MNSI quartile (p = 0.001). A multivariate analysis revealed that the peroneal NCV was independently associated with MNSI score after adjusting for age, sex, and glycosylated hemoglobin A1c (HbA1c) levels.

Conclusions

The present results indicate that a decrease in peroneal NCV was responsible for early sensory deficits in T2DM patients.

Keywords: Diabetic peripheral neuropathy, Nerve conduction study, Michigan Neuropathy Screening Instrument, Peroneal nerve

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Table 1.

Clinical characteristic of study subjects

Characteristic	Value
Female	198 (41.9)
Age (years)	62.6 ± 12.7
BMI (kg/m²)	23.7 ± 3.3
Duration of diabetes (years)	12.7 ± 8.4
Hypertension	99 (50.0)
Retinopathy	51 (25.8)
HbA1c (%)	9.0 ± 2.7
FPG (mg/dL)	202.4 ± 103.3
TC (mg/dL)	167.2 ± 44.9
TG (mg/dL)	150.4 ± 85.4
HDL-C (mg/dL)	45.0 ± 12.2
LDL-C (mg/dL)	110.0 ± 32.5
MNSI (score)	2.8 ± 2.3
DPN	69 (34.8)
Abnormal NCS	130 (65.7)

Values are expressed as means ± standard deviation for continuous vari-ables and frequency (%) for categorical variables.

BMI, body mass index; HbA1c, glycosylated hemoglobin; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol; MNSI, Michigan Neuropathy Screening Instrument; DPN, diabetic peripheral neuropathy; NCS, nerve conduction study.

Table 2.

Correlation between MNSI score and NCS variable

	Pearson's coefficient	p-values
MMDL	0.17	0.019
MMV	–0.20	0.005
MSNAP	–0.01	0.913
MSV	–0.13	0.071
UMDL	0.06	0.439
UMV	–0.09	0.216
USNAP	–0.08	0.270
USV	–0.16	0.030
PDL	0.07	0.381
PV	–0.19	0.012
TDL	0.11	0.128
TV	–0.16	0.024
Samp	–0.15	0.058
SuV	–0.159	0.041

MNSI, Michigan Neuropathy Screening Instrument; NCS, nerve conduction study; MMDL, median motor distal latency; MMV, median motor conduction velocity; MSNAP, median sensory nerve action potential amplitude; MSV, median sensory conduction velocity; UMDL, ulnar mo-tor distal latency; UMV, ulnar motor conduction velocity; USNAP, ulnar sensory nerve action potential amplitude; USV, ulnar sensory conduction velocity; PDL, peroneal distal latency; PV, peroneal conduction velocity; TDL, tibial distal latency; TV, tibial conduction velocity; Samp, sural ampli-tude; SuV, sural conduction velocity.

Table 3.

Clinical characteristics and NCS variables according to the quartiles of MNSI score

Variable	Quartiles of MNSI score				p-value for trend
Variable	Q1 (0)(n = 43)	Q2 (1–2)(n =51)	Q3 (3–4)(n =61)	Q4 (5–9)(n =43)	p-value for trend
MNSI score	0 (0)	1 (1–1.6)	3 (3–3.5)	6 (5.8–6.6)	< 0.001
Female	13 (30.2)	22 (43.1)	23 (37.7)	25 (58.1)	0.057
Age (years)	59.4 ± 12.8	65.3 ± 11.0	65.1 ± 12.8	59.4 ± 1.3±	0.013±
BMI (kg/m²)	23.7 ± 3.9	23.4 ± 3.2	24.0 ± 3.0	23.6 ± 11.7	0.765
Duration of diabetes (years)	12.0 ± 6.6	11.6 ± 8.3	14.3 ± 9.2	12.3 ± 3.3	0.322±
Hypertension	18 (41.9)	26 (51.0)	31 (50.8)	24 (55.8)	0.624
Retinopathy	11 (37.9)	13 (37.1)	18 (43.9)	9 (37.5)	0.989±
HbA1c (%)	8.5 ± 2.6	8.9 ± 2.2	9.1 ± 3.0	9.2 ± 8.8	0.654
FPG (mg/dL)	149.6 ± 26.5	175.6 ± 53.6	210.0 ± 146.0	284.7 ± 2.8	0.062±
TC (mg/dL)	162.3 ± 42.2	171.2 ± 39.0	167.4 ± 48.7	167.2 ± 82.9	0.879
TG (mg/dL)	146.9 ± 86.0	141.0 ± 98.3	152.5 ± 79.2	164.1 ± 48.4	0.741±
HDL-C (mg/dL)	44.1 ± 11.3	44.2 ± 11.9	46.2 ± 14.0	45.2 ± 75.8	0.882
LDL-C (mg/dL)	102.2 ± 29.1	108.5 ± 31.8	113.6 ± 32.6	114.9 ± 11.5	0.433±
Abnormal NCS	25 (58.1)	36 (70.6)	39 (63.0)	30 (69.8)	0.566
DPN	0 (0.0)	0 (0.0)	39 (63.9)	30 (69.8)	< 0.001±
MMDL (ms)	3.6 ± 0.7	3.7 ± 0.5	3.8 ± 0.7	3.9 ± 0.3	0.168
MMV (m/sec)	52.2 ± 4.0	50.4 ± 5.4	50.7 ± 4.8	49.3 ± 8.3	0.074
MSNAP (μV)	15.7 ± 7.3	15.6 ± 8.8	16.2 ± 8.8	16.4 ± 5.4	0.964
MSV (m/sec)	43.1 ± 6.6	40.3 ± 5.8	41.0 ± 6.5	40.1 ± 10.9	0.103
UMDL (ms)	2.7 ± 0.4	2.8 ± 0.5	2.8 ± 0.5	2.8 ± 6.5	0.520
UMV (m/sec)	50.6 ± 6.6	51.3 ± 6.1	50.9 ± 7.2	49.8 ± 0.4	0.733
USNAP (μV)	13.4 ± 7.6	12.7 ± 6.2	12.4 ± 7.2	12.3 ± 7.3	0.897
USV (m/sec)	42.8 ± 5.1	41.7 ± 4.8	41.1 ± 5.2	40.4 ± 6.2	0.212
PDL (ms)	3.7 ± 0.9	4.1 ± 0.7	4.1 ± 0.9	3.9 ± 0.5	0.063
PV (m/sec)	45.0 ± 6.3	40.3 ± 4.8	40.9 ± 5.6	41.0 ± 0.7	0.001
TDL (ms)	3.9 ± 0.7	4.1 ± 0.8	4.0 ± 0.6	4.2 ± 0.6	0.388
TV (m/sec)	42.3 ± 4.9	40.5 ± 6.3	40.4 ± 5.3	39.1 ± 0.6	0.098
Samp (μV)	15.5 ± 9.0	12.9 ± 7.1	11.9 ± 6.2	12.5 ± 6.6	0.135
SuV (m/sec)	37.2 ± 5.2	35.7 ± 3.9	35.2 ± 4.5	35.2 ± 7.5	0.203

Values are presented as mean ± standard deviation or median (interquatile range) for continuous variables and frequency (%) for categorical variables. Q1/Q2/Q3/Q4, first, second, third, and fourth quartiles, respectively; MNSI, Michigan Neuropathy Screening Instrument; BMI, body mass index; HbA1c, gly-cosylated hemoglobin; FPG, fasting plasma glucose; TC, total cholesterol; TG, triglyceride; HDL-C, high density lipoprotein-cholesterol; LDL-C, low density lipoprotein-cholesterol; NCS, nerve conduction study; DPN, diabetic peripheral neuropathy; MMDL, median motor distal latency; MMV, median motor conduction velocity; MSNAP, median sensory nerve action potential amplitude; MSV, median sensory conduction velocity; UMDL, ulnar motor distal latency; UMV, ulnar motor conduction velocity; USNAP, ulnar sensory nerve action potential amplitude; USV, ulnar sensory conduction velocity; PDL, pero-neal distal latency; PV, peroneal conduction velocity; TDL, tibial distal latency; TV, tibial conduction velocity; Samp, sural amplitude; SuV, sural conduction velocity.

Table 4.

Multivariate analysis for the relationship between clinical and NCS parameters and MNSI score

	Unstandardized coefficients		Standardized coefficients	p-value
	β	SE	β	p-value
Constant	0.654	1.918		0.001
Age	–0.017	0.014	–0.096	0.223
Sex (female)	0.490	0.333	0.111	0.143
HbA1c (%)	0.022	0.069	0.026	0.745
PV	–0.008	0.003	–0.206	0.009
Adjusted R²	0.08

Adjusted for age, sex, glycosylated hemoglobin and peroneal conduction velocity.

NCS, nerve conduction study; MNSI, Michigan Neuropathy Screening Instrument; SE, standard error; HbA1c, glycosylated hemoglobin; PV, pe-roneal conduction velocity.

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