Conference abstract
Sensitivity of clinical evaluation for discriminating small and large fiber diabetic neuropathy: a cross-sectional study
Pan African Medical Journal - Conference Proceedings. 2023:19(6).23
Nov 2023.
doi: 10.11604/pamj-cp.2023.19.6.1913
Archived on: 23 Nov 2023
Contact the corresponding author
Keywords: Diabetic neuropathy, clinical evaluation, small fiber neuropathy, large fiber dysfunction
Oral presentation
Sensitivity of clinical evaluation for discriminating small and large fiber diabetic neuropathy: a cross-sectional study
Eric Samuel Chokote1,2,&, Gaëlle Lemdjo1, Aurélien Anakeu3, Leonard Nfor Njamnshi2,4, Leonard Ngarka2,4,5, Francine Mendane Mekobe5,6, Ruth Joelle Ngongang1, Eugène Sobngwi4,5, Jean Claude Mbanya4,5, Alfred Kognyuy Njamnshi2,4,5
1Jordan Medical Services, Yaoundé, Cameroon, 2Brain Research Africa Initiative Foundation, Yaoundé, Cameroon, 3Company Criystallise Limited, United Kingdom, 4Yaoundé Central Hospital, Yaoundé, Cameroon, 5Faculty of Medicine and Biomedical Sciences, the University of Yaoundé I, Yaoundé, Cameroon
&Corresponding author
Introduction: routine clinical evaluation is usually considered sufficient for screening classical diabetic polyneuropathy (DPN) and the American Diabetes Association states that electrophysiological testing is not cost-effective. There is however a paradigm shift towards early diagnosis at the stage of reversible pure small fiber neuropathy (SFN). We therefore aim to investigate the sensitivity of clinical evaluation for discriminating small and large fiber dysfunction.
Methods: patients were consecutively recruited from the cohort of the diabetic neuropathy clinic of Jordan Medical Services, Yaounde, Cameroon from February 2022 to January 2023. The Toronto Clinical Neuropathy Score and the SFN 2008 criteria were used for classifying Small and large fiber neuropathies. Electrochemical skin conductance (ESC) of hands and feet recorded by SUDOSCAN and Nerve Conduction studies (NCS) were used as reference for small and large fiber functions respectively.
Results: a total of 71 patients were included (96% type 2, 2.7% glucose intolerance, and 1.3% type 1). Mean age was 57.85± 10.79 with a Male/female sex ratio of 1.9:1. Mean HbA1c was 7.82±1.92. Based on clinical criteria, DPN was diagnosed in 80% of patients (large fiber 63.3% vs small fiber 36,7%). Mean ESC scores were. 60.07±14.57 and 61.27±12.93microsiemens for feet and hands respectively. The overall prevalence of DPN was 73.2% and that of pure SFN was 25.3%. The level of agreement between clinical and electrophysiological diagnosis was poor (kappa = 0.3). Clinical evaluation correctly classified only 7 patients on 18 (38.9%) with SFN and 27 patients on 34 (79.4%) with large fiber dysfunction.
Conclusion: clinical evaluation has a low sensitivity of discriminating between small and large fiber DPN. Simple paraclinical tools evaluating both small and large fibers should be included in the routine assessment of diabetic patients for appropriate diagnosis and classification of diabetic neuropathy.
Sensitivity of clinical evaluation for discriminating small and large fiber diabetic neuropathy: a cross-sectional study
Eric Samuel Chokote1,2,&, Gaëlle Lemdjo1, Aurélien Anakeu3, Leonard Nfor Njamnshi2,4, Leonard Ngarka2,4,5, Francine Mendane Mekobe5,6, Ruth Joelle Ngongang1, Eugène Sobngwi4,5, Jean Claude Mbanya4,5, Alfred Kognyuy Njamnshi2,4,5
1Jordan Medical Services, Yaoundé, Cameroon, 2Brain Research Africa Initiative Foundation, Yaoundé, Cameroon, 3Company Criystallise Limited, United Kingdom, 4Yaoundé Central Hospital, Yaoundé, Cameroon, 5Faculty of Medicine and Biomedical Sciences, the University of Yaoundé I, Yaoundé, Cameroon
&Corresponding author
Introduction: routine clinical evaluation is usually considered sufficient for screening classical diabetic polyneuropathy (DPN) and the American Diabetes Association states that electrophysiological testing is not cost-effective. There is however a paradigm shift towards early diagnosis at the stage of reversible pure small fiber neuropathy (SFN). We therefore aim to investigate the sensitivity of clinical evaluation for discriminating small and large fiber dysfunction.
Methods: patients were consecutively recruited from the cohort of the diabetic neuropathy clinic of Jordan Medical Services, Yaounde, Cameroon from February 2022 to January 2023. The Toronto Clinical Neuropathy Score and the SFN 2008 criteria were used for classifying Small and large fiber neuropathies. Electrochemical skin conductance (ESC) of hands and feet recorded by SUDOSCAN and Nerve Conduction studies (NCS) were used as reference for small and large fiber functions respectively.
Results: a total of 71 patients were included (96% type 2, 2.7% glucose intolerance, and 1.3% type 1). Mean age was 57.85± 10.79 with a Male/female sex ratio of 1.9:1. Mean HbA1c was 7.82±1.92. Based on clinical criteria, DPN was diagnosed in 80% of patients (large fiber 63.3% vs small fiber 36,7%). Mean ESC scores were. 60.07±14.57 and 61.27±12.93microsiemens for feet and hands respectively. The overall prevalence of DPN was 73.2% and that of pure SFN was 25.3%. The level of agreement between clinical and electrophysiological diagnosis was poor (kappa = 0.3). Clinical evaluation correctly classified only 7 patients on 18 (38.9%) with SFN and 27 patients on 34 (79.4%) with large fiber dysfunction.
Conclusion: clinical evaluation has a low sensitivity of discriminating between small and large fiber DPN. Simple paraclinical tools evaluating both small and large fibers should be included in the routine assessment of diabetic patients for appropriate diagnosis and classification of diabetic neuropathy.
