Clinical neuropathy scales in neuropathy associated with impaired glucose tolerance

J Diabetes Complications. 2015 Apr;29(3):372-7. doi: 10.1016/j.jdiacomp.2015.01.011. Epub 2015 Feb 3.


Aims: Disagreement exists on effective and sensitive outcome measures in neuropathy associated with impaired glucose tolerance (IGT). Nerve conduction studies and skin biopsies are costly, invasive and may have their problems with reproducibility and clinical applicability. A clinical measure of neuropathy that has sufficient sensitivity and correlates to invasive measures would enable significant future research.

Methods: Data was collected prospectively on patients with IGT and symptomatic early neuropathy (neuropathy symptoms <2years) and normal controls. The seven scales that were examined were the Neuropathy Impairment Score of the Lower Limb (NIS-LL), Michigan Diabetic Neuropathy Score (MNDS), modified Toronto Clinical Neuropathy Scale (mTCNS), Total Neuropathy Score (Clinical) (TNSc), The Utah Early Neuropathy Scale (UENS), the Early Neuropathy Score (ENS), and the Neuropathy Disability Score (NDS).

Results: All seven clinical scales were determined to be excellent in discriminating between patients with neuropathy from controls without neuropathy. The strongest discrimination was seen with the mTCNS. The best sensitivity and specificity for the range of scores obtained, as determined by using receiver operating characteristic curves, was seen for the mTCNS followed by the TNSc. Most scales show a stronger correlation with measures of large rather than small fiber neuropathy.

Conclusions: All seven scales identify patients with neuropathy. For the purpose of screening potential patients for a clinical study, the mTCNS followed by the TNSc would be most helpful to select patients with neuropathy.

Keywords: Clinical scales; Diabetes; Impaired glucose regulation; Neuropathy; Screening tools.

Publication types

  • Clinical Trial

MeSH terms

  • Aged
  • Area Under Curve
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetic Neuropathies / complications
  • Diabetic Neuropathies / diagnosis
  • Diagnostic Techniques, Neurological / standards*
  • Diagnostic Techniques, Neurological / statistics & numerical data
  • Female
  • Glucose Intolerance / complications*
  • Glucose Intolerance / diagnosis*
  • Humans
  • Male
  • Middle Aged
  • Peripheral Nervous System Diseases / complications*
  • Peripheral Nervous System Diseases / diagnosis*
  • Reproducibility of Results
  • Research Design / standards
  • Research Design / statistics & numerical data
  • Sensitivity and Specificity