Diagnostic Accuracy of Screening Tests for Diabetic Peripheral Neuropathy Among Outpatient Attendees of Follow-Up Care for Diabetes in Central India.

Background and objectives Of the several screening tests used in the screening of diabetic peripheral neuropathy (DPN), each has its demerits, which pose a threat to reliability. There is no single optimal method for the early diagnosis of DPN. This study was conducted to compare the diagnostic accuracy of monofilament, biothesiometer, and symptom-based scoring in detecting DPN, to determine the optimal cut-off for biothesiometer score compared to nerve conduction studies (NCS), and to compare the time taken to screen with monofilament and biothesiometer. Material and methods This cross-sectional, comparative, diagnostic accuracy study was conducted in a tertiary care institute in Central India. Among the patients with diabetes mellitus (DM), those who were advised NCS between March and October 2023 were included in the study. Results and discussion A total of 78 limbs among 39 patients with diabetes were assessed for DPN. The sensitivity of clinical scoring, monofilament, and biothesiometer (cut-off = 10) was 15.6% (5.3-32.8), 35.5% (23.7-48.7), and 71% (58.1-81.8), respectively. A biothesiometer score of 10 was identified as optimal, with an area under the curve of 0.7132 (0.56-0.87), and the time taken to administer the biothesiometer was about 2.5 times more compared to the monofilament assessment. Conclusions Biothesiometry has higher sensitivity compared to other screening methods. The biothesiometer cut-off at 10 had higher sensitivity compared to the existing standards of 15mV. The need for a lower cut-off for biothesiometry has to be established with reference to NCS standards in larger studies.