The natural history of diabetic peripheral neuropathy determined by a 12 year prospective study using vibration perception thresholds

• Published in: Journal of clinical neuroscience Vol. 8; no. 6; pp. 520 - 524
• Main Authors: Coppini, D.V., Wellmer, A., Weng, C., Young, P.J., Anand, P., Sönksen, P.H.
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Ltd 01-11-2001; Elsevier
• Subjects: Adult; Ankle Joint; Associated diseases and complications; Biological and medical sciences; diabetes mellitus, neuropathy, vibration perception threshold (VPT), VPTscore, risk factors; Diabetes. Impaired glucose tolerance; Diabetic Neuropathies - diagnosis; Diabetic Neuropathies - epidemiology; Diabetic Neuropathies - physiopathology; Disease Progression; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Male; Medical sciences; Middle Aged; Prospective Studies; Reflex; Risk Factors; Sensory Thresholds; Vibration; diabetes mellitus, neuropathy, vibration perception threshold (VPT), VPTscore, risk factors; Endocrinopathy; Human; Prevention; Nervous system diseases; Vibration; Diabetes mellitus; Perception threshold; Risk factor; Evolution; Peripheral nerve disease; Peripheral neuropathy
• ISSN: 0967-5868; 1532-2653
• DOI: 10.1054/jocn.2001.0893

The development and long term progression of diabetic peripheral neuropathy was studied using vibration perception threshold (VPT) as a validated measure. Three hundred and ninety-two patients had a normal age corrected VPT (12.1±3.7 volts) at baseline, with an age corrected logarithmic VPTscore <12. 19.9% developed an abnormal VPT over a 12 year period, increasing from 14.2±3.7 volts (VPTscore 10.4±0.6) at baseline to 35.9±9.5 volts (VPTscore 12.6±0.45) at follow up (P = 0.0001), and from 10.1±3.7volts (VPTscore 9.4±0.8) to 14.2±4.7 (VPTscore 9.8±0.8) in the rest. Over 80% thus retained a ‘normal’ VPT after a mean diabetes duration of 16 years despite only average glycaemic control, suggesting that non-ideal long term glycaemic control leads to neuropathy in a subset of predisposed patients. VPT was correlated in 123 diabetic patients with definitive criteria for neuropathy and a range of quantitative sensory and autonomic tests. 62/63 patients with abnormal VPT fulfilled neuropathy criteria; of patients with normal VPT who fulfilled neuropathy criteria, all had at least one abnormal thermal threshold test result. We conclude that a combination of log-transformed VPT values (VPTscore >10.1) and thermal thresholds can identify diabetic patients at risk of developing peripheral neuropathy and select patients likely to benefit from prophylaxis in clinical trials.