Diagnostic accuracy and reliability of the neurological and arterial tests according to the IWGDF guidelines in the diagnosis of diabetic peripheral neuropathy and peripheral arterial disease in type 2 diabetic patients attending the primary health care
DOI:
https://doi.org/10.24265/horizmed.2018.v18n3.03Keywords:
Diagnosis, Diabetic neuropathies, Peripheral arterial disease, Diabetes mellitusAbstract
Objective: To determine the diagnostic accuracy and reliability of the neurological test (NT) and the arterial test (AT) according to the International Working Group on the Diabetic Foot (IWGDF) guidelines in the diagnosis of diabetic peripheral neuropathy (DPN) and peripheral arterial disease (PAD), respectively, using variables such as sensitivity (Se), specificity (Sp), positive predictive value (PPV), and positive likelihood ratio (PLR) in type 2 diabetic patients attending the primary health care. Materials and methods: One hundred (100) type 2 diabetic patients were chosen from the public primary health care system, and evaluated by a primary physician in a private diabetic foot unit. The NT was represented by the tactile-vibratory sensitivity and the AT by the ankle-brachial index according to the IWGDF guidelines. They were compared to standard neurological and arterial tests called Michigan Neuropathy Screening Instrument and Duplex Doppler Ultrasound, respectively, and performed by a diabetic foot specialist. Results: The NT showed an Se and Sp of 100 % and 94 % for the DPN, and the AT showed an S and E of 67.3 % and 83.2 % for the PAD, as well as a high PPV. The PLR was good in the NT, but poor in the AT. Conclusions: Accuracy and reliability of the NT and AT according to the IWGDF guidelines were adequate to diagnose DPN and PAD, respectively, in type 2 diabetic patients attending the primary health care, whose values were very similar to other studies’ but affected by local factors.
Downloads
References
Cavan D, Fernandes J, Makaroff L, Ogurtsova K, Webber S. IDF Diabetes Atlas. 7th Ed. Belgium: International diabetes Federation; 2015.
Perú, Ministerio de Salud. Situación de la Vigilancia Epidemiológica de Diabetes en establecimientos de salud, Lima, 2016 [Internet].Disponible en: http://www.dge.gob.pe
Boulton A, Vileikyte A. Painful Diabetic Neuropathy in Clinical Practice. 1st ed. Heidenberg: Springer; 2011.
Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116(9):1509-26.
Frykberg R, Zgnois T, Armstrong D, Driver V, Giurini J. Diabetic foot disorders: a clinical practice guideline. J Foot Ankle Surg. 2006; 45(5): S1–S66.
Mete T, Aydin Y, Saka M, Cinar H, Bilen S, Yalcin Y, et al. Comparison of Efficiencies of Michigan Neuropathy Screening Instrument, Neurothesiometer, and Electromyography for Diagnosis of Diabetic Neuropathy. Int J Endocrinol.2013;2013:821745.
Xiong Q, Lu B, Ye H, Wu X, Zhang T, Li Y. The Diagnostic Value of Neuropathy Symptom and Change Score, Neuropathy Impairment Score and Michigan Neuropathy Screening Instrument for Diabetic Peripheral Neuropathy. Eur Neurol. 2015;74(5-6):323-7.
Azam S, Carman T. Diagnostic Approach to Peripheral Arterial Disease. Cardiol Clin 2011; 29: 319-29.
Franz RW, Jump MA, Spalding MC, Jenkins JJ. Accuracy of duplex ultrasonography in estimation of severity of peripheral vascular disease. Int J Angiol. 2013 ;22(3):155-8.
Schaper N, Van Netten J, Apelqvist J, Lipsky B et al. Prevention and management of foot problems in diabetes: a Summary Guidance for Daily Practice 2015, based on the IWGDF Guidance Documents. Diabetes Metab Res Rev. 2016; 32 (1):7-15.
Hinchliffe RJ, Brownrigg JR, Apelqvist J, Boyko EJ et al. IWGDF guidance on the diagnosis, prognosis and management of peripheral artery disease in patients with foot ulcers in diabetes. Diabetes Metab Res Rev 2016 ;32(1):37-44.
Lavery L, Peters EJ, William JR, Murdoch DP, Hudson A, Lavery DC, et al. Reevaluating the way we classify the diabetic foot: restructuring the diabetic foot risk classification of the IWGDF. Diabetes Care. 2008; 31: 154–6.
Adam Bujang M, Hilda Adnan T. Requirements for Minimum Sample Size for Sensitivity and Specificity Analysis. J Clin Diagn Res. 2016; 10(10):1-6.
Del Brutto OH, Mera RM, King NR, Zambrano M, Sullivan LJ. The burden of diabetes-related foot disorders in community- dwellers living in rural Ecuador: Results of the Atahualpa Project. Foot. 2016; 28:26-29.
Mendoza-Romo M, Ramirez-Arriola M, Velasco-Chavez J, Nieva de Jesus R, Rodriguez-Perez CV, Valdez-Jimenez LA. Sensibilidad y especificidad de un modelo de utilidad para la detección de neuropatía diabética. Rev Med Inst Mex Seguro Soc. 2013; 51(1):34-41.
Vega J, Romaní S, Garcipérez FJ, Vicente L, Pacheco N, Zamorano J, et al. Peripheral Arterial Disease: Efficacy of the oscillometric method. Rev Esp Cardiol. 2011; 64(7):619–621.
Michigan Diabetes Research and Training Center [internet]. Tools for Health Professionals, Survey Instruments: Michigan Neuropathy Screening Instrument (MNSI) 2016. Disponible en: http://diabetesresearch.med.umich.edu/Tools_SurveyInstruments.php
Gerhard-Herman M, Gardin JM, Jaff M, Mohler E, Roman M, Naqvi TZ, et al. Guidelines for noninvasive vascular laboratory testing: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med. 2006 ;11(3):183-200.
Manterola C. Cómo interpretar un artículo sobre pruebas diagnósticas. Rev Med Clin Condes. 2009; 20(5): 708–717.
World Medical Association. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Subjects. JAMA. 2013; 310(20):2191-4.
Thomas RL, Zidan MA, Slovis TL. What you need to know about statistics Part I: validity of diagnostic and screening tests. Pediatr Radiol. 2015; 45(2):146-52.
Thompson M, Van den Bruel A. Diagnostic Tests Toolkit. 1rst ed, John Wiley & Sons, Ltd.; 2012:3-4.
Moreira do Nascimento OJ, Branco PupeCC, Uchôa Cavalcanti CB. Diabetic neuropathy. Rev Dor São Paulo. 2016;17(1): S46-51.
European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, Baumgartner I, Clément D, et al. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: The Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology ESC. Eur Heart J. 2011 ;32(22):2851-906.
Eusebi P. Diagnostic Accuracy Measures. Cerebrovasc Dis. 2013; 36(4):267–272.
Bravo-Grau S, Cruz Q. Estudios de exactitud diagnóstica: Herramientas para su Interpretación. Rev Chil Radiol. 2015; 21 (4): 158-164.
Najafi L, Khamseh M, Malek M, Baradaran H, Aghili SM, Kia M, et al. Rapid Screening of Diabetic Polyneuropathy: Selection of Accurate Symptoms and Signs in an Outpatient Clinical Setting. Acta Med Iranica. 2014; 52(7):519-27.
Jayaprakash P, Bhansali A, Bhansali S, Dutta P, Anantharaman R, Shanmugasundar G, et al. Validation of bedside methods in evaluation of diabetic peripheral Neuropathy. Indian J Med Res. 2011; 133(6): 645-649.
Al-Geffari M. Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting. Int J Health Sc (Qassim). 2012; 6(2):109-115.
Lui F, Bao J, Hu R, Zhnag X, Li H, Zhu D, et al. Screening and prevalence of peripheral neuropathy in type 2 diabetic outpatients: a randomized multicentre survey in 12 city hospitals of China. Diabetes Metab Res Rev. 2010; 26(6): 481–489.
Aubert CE, Cluzel P, Kemel S, Michel PL, Lajat-Kiss F, Dadon M, et al. Influence of peripheral vascular calcification on efficiency of screening tests for peripheral arterial occlusive disease in diabetes—a cross-sectional study. Diabet Med. 2014; 23(2):192-199.
Premalatha G, Ravikumar R, Sanjay R, Mohan B. Comparison of colour duplex ultrasound and ankle–brachial pressure index measurements in peripheral vascular disease in type 2 diabetic patients with foot infections. J Assoc Physicians India. 2002; 50: 1240–1244.
Manzaneda A, Lazo M, Malaga G. Actividad física en pacientes ambulatorios con diabetes mellitus 2 de un Hospital Nacional del Perú. Rev Peru Med Exp Salud Pública. 2015; 32(2):311-5.
Whiting PF, Rutjes AW, Westwood ME, Mallett S; QUADAS-2 Steering Group. A systematic review classifies sources of bias and variation in diagnostic test accuracy studies. J Clin Epidemiol. 2013;66(10):1093-104.
Published
How to Cite
Issue
Section
License
Copyright (c) 2018 Horizonte Médico (Lima)
This work is licensed under a Creative Commons Attribution 4.0 International License.
Horizonte Médico (Lima) (Horiz. Med.) journal’s research outputs are published free of charge and are freely available to download under the open access model, aimed at disseminating works and experiences developed in biomedical and public health areas, both nationally and internationally, and promoting research in the different fields of human medicine. All manuscripts accepted and published in the journal are distributed free of charge under the terms of a Creative Commons license – Attribution 4.0 International (CC BY 4.0).
