OBJECTIVES: It is important to consider the symptoms of diabetic neuropathy in determining a diagnostic approach. To evaluate diabetic neuropathy, an appropriate questionnaire for Korean diabetic patients is required. In 1994, Feldman et al. proposed the two-step diagnostic approach which included a questionnaire. To adapt a diagnostic approach and questionnaire for Korean diabetics, we initially diagnosed diabetic neuropathy by using Feldman's method and by assessing the efficiency of their method for Korean diabetics as a preliminary study. METHODS: We diagnosed diabetic neuropathy with Feldman's method in 99 NIDDM patients who visited Ajou university hospital from October 1, 1996 to April 30, 1997. The sensitivity and specificity of Feldman's 4 diagnostic procedures were ebaluated. To include the highly specific symptoms in the diagnostic approach, we applied a different scoring system(from 5 to 1) to the questionnaire accroding to specificity and then evaluated the sensitivity and specificity with this new system. If the sensitivity and specificity were 60% or more, the new scoring system was regarded as clinically useful. RESULTS: Using Feldman's method, the sensitivity of MNSIQ and MNSIC was 12.8% and the specificity was 88.3% and 98.3%, respectively. The sensitivity of MDNS and NCV was 100% and the specificity was 68.3% and 61.6%, respectively. The new scoring system consisted of 13 of 15 questions with sensitivity of 46.2% and specificity of 71.7%, omitting 2 questions due to possible relation to vascular symptoms. Among the 4 diagnostic procedures, the strongest correlation existed between MDNS and NCV. None of the procedures had a significant correlatiion with MNSIQ. MNSIC, which shares similar characteristics with MDNS, had significant correlation with MDNS and NCV, but its sensitivity was very low. CONCLUSON: MNSIQ and MNSIC were not useful as screening instruments in the diagnostic approach to diabetic neuropathy using Feldman's method. Thus, a new questionnaire composed of symptoms common in Korean diabetic patients should be designed, and MNSIC could be omitted from the diagnostic approach.
Diabetes Mellitus, Type 2 ; Diabetic Neuropathies* ; Diagnosis ; Humans ; Mass Screening ; Sensitivity and Specificity ; Surveys and Questionnaires

No abstract available.
Diabetic Retinopathy ; Follow-Up Studies ; Humans ; Photography

BACKGROUND: Discrepancies exist in the currently available data on the prevalence of diabetic neuropathy. Variations in the prevalence of diabetic neuropathy have reflected the different criteria used to form its diagnosis. The majority of diagnostic criteria are less practical in many routine clinical settings where there is a need for a simple assessment using widely available techniques to rapidly screen large numbers of patients. We already reported that the questionnaire of Feldman's two-step assessment was less useful in Koreans, because of the different expression of neuropathic symptoms. We proposed a representative questionnaire which was based on patients' own complaints, and assessed its clinical availability. METHODS: Ninety diabetic patients(45 cases with diabetic neuropathy, 45 cases without neuropathy) were included in this study. Diabetic neuropathy was diagnosed by neurologic examination and nerve conduction velocity. The questionnaire consisted of 7 questions on foot sensation (prickling, lancinating, burning, numb), which are frequent complaints of diabetic patients. All subjects were assessed with the questionnaire. RESULTS: 1. The most sensitive symptom was tingling sensation (75.6%) and the least sensitive one was numbness(28.9%). 2. The most specific symptom was numbness(82.2%) and the least specific one was tingling sensation(33.3%). 3. If we would assume that three or more of symptoms were diagnostic, the sensitivity and specificity were 66.7% and 53.3%, respectively. CONCLUSION: Our new questionnaire can be used as a screening test or a follow-up tool for the diagnosis of diabetic peripheral neuropathy in Koreans.
Burns ; Diabetic Neuropathies ; Diagnosis* ; Follow-Up Studies ; Foot ; Humans ; Mass Screening ; Neural Conduction ; Neurologic Examination ; Peripheral Nervous System Diseases* ; Prevalence ; Sensation ; Sensitivity and Specificity ; Surveys and Questionnaires