In each research center, doctors advised patients who were in accordance with inclusion criteria to become familiar with the study information and obtain informed consent then referred to the investigator to conduct the screening. Exclusion criteria were (1) type 1 diabetes mellitus (2) history of nerve root compression, cerebral vascular disease, hypothyroidism, pernicious anemia, alcoholism and using of drugs that’s may cause neuropathy. Subject inclusion criteria were as follows: (1) Patients aged 35 to 70 years (2) male or female (3) diagnosis of Type 2 diabetes mellitus according to World Health Organization 1999 criteria (4) willingness to sign informed consent form. This was a multicenter cross-sectional study carried out in Primary Health Care clinics in National Guard in Riyadh. Therefore, the objective of this study was to compare between this screening tests in the detection of DPN in primary health care (PHC) setting. It’s ranging from quantitative methods, such as nerve conduction studies and vibration sense testing, to validated questionnaires such as MNSI or clinical examinations such as pressure sensation by using 10 g Semmes-Weinstein Monofilament (SWM), vibration sensation by tuning fork and ankle reflex. ( 14)Ī number of methods can be used as a screening for detecting diabetic peripheral neuropathy. A simple method that has ease of use for the regular evaluation and diagnosis of DPN in the primary care setting is needed. While the gold standard for diagnosis of DPN continues to be a nerve conduction study, that is time consuming, requires a separate patient visit, and is costly which cannot be recommended for screening. ( 7) Early intervention strategies can prevent foot ulcers and amputation while preserving the quality of life ( 8– 10) and ameliorating the social and economic costs of diabetic foot disease. ( 4, 5)Īs the incidence of type 2 diabetes mellitus (T2DM) increases ( 6) every year, it has been recommended that prevention of DPN and/or early diagnosis should become high priority matters at the primary care level, where the majority of health care visits for diabetic patients take place. ( 1, 2, 3) Foot disorders remain a major source of morbidity and a leading cause of hospitalization among people with diabetes mellitus. It’s accounts for 50–75% of non-traumatic amputations in diabetic patients. It is defined by international consensus guidelines as “the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after exclusion of other causes”. We conclude that the Rydel-Seiffer graduated tuning fork is a suitable tool for screening for sensation loss and that diabetic patients with a tuning-fork score of less than or equal to 4.0 are vulnerable to ulceration.Diabetic Peripheral Neuropathy (DPN) is one of the most common complications of diabetes and stands as a major pathophysiological risk factor for foot ulcers and amputation. The tuning fork score was less than or equal to 4.0 in 95% of the ulcerated feet. Age-related Rydel-Seiffer tuning fork vibration sensation was impaired in 79% of 38 ulcerated feet of 26 patients. It correlated well (r = -0.90, p less than 0.001) with the thresholds obtained with an electromagnetic instrument (Vibrameter) in diabetic patients, in whom vibration perception score was impaired compared with control subjects (4.0 +/- 1.8 (+/- SD) vs 5.4 +/- 1.4, p less than 0.001). Vibration perception score measured with the tuning fork declined with age (p less than 0.001) in the control subjects. The performance of the Rydel-Seiffer graduated tuning fork was examined in healthy subjects and in various groups of diabetic patients in order to evaluate its efficacy for identifying patients whose loss of vibration sensation may expose them to the risk of foot injury.
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