Journal List > Ann Clin Neurophysiol > v.21(1) > 1121229

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

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.

References

1. Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev. 2012; 28(Suppl 1):8–14.
crossref
2. Malik RA, Tesfaye S, Newrick PG, Walker D, Rajbhandari SM, Siddique I, et al. Sural nerve pathology in diabetic patients with minimal but progressive neuropathy. Diabetologia. 2005; 48:578–585.
crossref
3. Caputo GM, Cavanagh PR, Ulbrecht JS, Gibbons GW, Karchmer AW. Assessment and management of foot disease in patients with diabetes. N Engl J Med. 1994; 331:854–860.
crossref
4. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010; 33:2285–2293.
crossref
5. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005; 64:199–207.
crossref
6. Pastore C, Izura V, Geijo-Barrientos E, Dominguez JR. A comparison of electrophysiological tests for the early diagnosis of diabetic neuropathy. Muscle Nerve. 1999; 22:1667–1673.
crossref
7. Malik RA, Veves A, Tesfaye S, Smith G, Cameron N, Zochodne D, et al. Small fibre neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy. Diabetes Metab Res Rev. 2011; 27:678–684.
crossref
8. Dyck PJ, Karnes JL, Daube J, O'Brien P, Service FJ. Clinical and neuropathological criteria for the diagnosis and staging of diabetic polyneuropathy. Brain. 1985; 108(Pt 4):861–880.
crossref
9. Dyck PJ, Karnes JL, O'Brien PC, Litchy WJ, Low PA, Melton LJ 3rd. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria for diagnosis and staged severity. Neurology. 1992; 42:1164–1170.
10. Dyck PJ, O'Brien PC, Litchy WJ, Harper CM, Klein CJ. Monotonicity of nerve tests in diabetes: subclinical nerve dysfunction precedes diagnosis of polyneuropathy. Diabetes Care. 2005; 28:2192–2200.
11. Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001; 24:250–256.
crossref
12. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994; 17:1281–1289.
crossref
13. Lunetta M, Le Moli R, Grasso G, Sangiorgio L. A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy. Diabetes Res Clin Pract. 1998; 39:165–172.
crossref
14. Johnsen B, Fuglsang-Frederiksen A. Electrodiagnosis of polyneuropathy. Neurophysiol Clin. 2000; 30:339–351.
crossref
15. Kim SS, Won JC, Kwon HS, Kim CH, Lee JH, Park TS, et al. Prevalence and clinical implications of painful diabetic peripheral neuropathy in type 2 diabetes: results from a nationwide hos-pital-based study of diabetic neuropathy in Korea. Diabetes Res Clin Pract. 2014; 103:522–529.
crossref
16. Charles M, Soedamah-Muthu SS, Tesfaye S, Fuller JH, Arezzo JC, Chaturvedi N, et al. Low peripheral nerve conduction velocities and amplitudes are strongly related to diabetic microvascular complications in type 1 diabetes: the EURODIAB Prospective Complications Study. Diabetes Care. 2010; 33:2648–2653.
17. Mauer SM, Goetz FC, McHugh LE, Sutherland DE, Barbosa J, Najarian JS, et al. Long-term study of normal kidneys transplanted into patients with type I diabetes. Diabetes. 1989; 38:516–523.
crossref
18. lbers JW, Herman WH, Pop-Busui R, Martin CL, Cleary P, Waberski B. Subclinical neuropathy among Diabetes Control and Compli-cations Trial participants without diagnosable neuropathy at trial completion: possible predictors of incident neuropathy? Diabetes Care. 2007; 30:2613–2618.
19. Diabetes Control and Complications Trial (DCCT): results of feasibility study. The DCCT Research Group. Diabetes Care. 1987; 10:1–19.
20. Tkac I, Bril V. Glycemic control is related to the electrophysiologic severity of diabetic peripheral sensorimotor polyneuropathy. Diabetes Care. 1998; 21:1749–1752.
crossref
21. Won JC, Kwon HS, Kim CH, Lee JH, Park TS, Ko KS, et al. Prevalence and clinical characteristics of diabetic peripheral neuropathy in hospital patients with type 2 diabetes in Korea. Diabet Med. 2012; 29:e290–e296.
22. Baba M, Ozaki I. Electrophysiological changes in diabetic neuropathy: from subclinical alterations to disabling abnormalities. Arch Physiol Biochem. 2001; 109:234–240.
crossref
23. Dyck PJ, Karnes JL, O'Brien P, Okazaki H, Lais A, Engelstad J. The spatial distribution of fiber loss in diabetic polyneuropathy suggests ischemia. Ann Neurol. 1986; 19:440–449.
crossref
24. Albers JW, Brown MB, Sima AA, Greene DA. Nerve conduction measures in mild diabetic neuropathy in the Early Diabetes Intervention Trial: the effects of age, sex, type of diabetes, disease duration, and anthropometric factors. Tolrestat Study Group for the Early Diabetes Intervention Trial. Neurology. 1996; 46:85–91.
25. Binns-Hall O, Selvarajah D, Sanger D, Walker J, Scott A, Tesfaye S. One-stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high-risk foot. Diabet Med. 2018; 35:887–894.
crossref

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
Q1 (0)(n = 43) Q2 (1–2)(n =51) Q3 (3–4)(n =61) Q4 (5–9)(n =43)
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
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.

TOOLS
Similar articles