Duration of disease, neuropathic symptoms, and plantar sensitivity in patients with diabetes with and without previous plantar ulceration.

TLDR: The symptoms alone are not able to differentiate between neuropathic subjects with different progressions of diabetic peripheral neuropathy (DPN), and duration of diabetes and symptoms did not explain the severity of neuropathy in people with a diabetic ulcer.

Abstract:  This study compared the duration of disease, the prevalence of neuropathy symptoms, and plantar insensitivity among subjects with diabetic neuropathy, with and without previous history of plantar ulcers, to a nondiabetic group of subjects. Correlations were made between the neuropathic symptoms observed and the results of sensory tests. Thermal and tactile sensitivities and sensitive chronaxie were measured in the control group (CG, n = 19), a diabetic neuropathic group (DG, n = 16), and a diabetic neuropathic group with previous history of plantar ulceration (UDG, n = 9). Plantar sensitivity was investigated in 5 areas of the plantar surface of both feet: heel, midfoot, lateral forefoot, medial forefoot, and hallux. The neuropathy symptoms were investigated using the Michigan Neuropathy Screening Instrument (MNSI). The neuropathic groups did not differ in duration of diabetes onset (DG = 13 years ± 8; UDG = 14 years ± 5; P = 0.243) and they presented similar mean for symptoms according to MNSI score (DG = 6.94 ± 1.81; UDG = 6.78 ± 2.44; P = 0.352). The frequency of subjects with abnormal sensitivity was higher in UDG. The MNSI showed moderate correlation with tactile sensitivity (r <-0.42, P <0.05). Patients with diabetic neuropathy and an ulcer had decreased sensitivity in their feet. The symptoms may indicate loss of sensation, but symptoms alone are not able to differentiate between neuropathic subjects with different progressions of diabetic peripheral neuropathy (DPN). Duration of diabetes and symptoms did not explain the severity of neuropathy in people with a diabetic ulcer.