Clinical and Electrophysiological Detection of Diabetic Neuropathy in Individuals with Type 2 Diabetes Mellitus: A Comparative Pilot Study in Western Maharashtra
DOI:
https://doi.org/10.46858/VIMSJPT/2026/v8.i1/51-57Keywords:
Clinical Examination, Diabetic Peripheral Neuropathy, Monofilament Test, Nerve Conduction Study, Pilot Study, Type 2 Diabetes Mellitus, Vibration PerceptionAbstract
Background: Diabetic peripheral neuropathy (DPN) is the most common chronic complication of type 2 diabetes mellitus (T2DM), and Indian studies report a prevalence ranging widely from about 9% to 78% depending on region and diagnostic method. Bedside clinical tests remain the first-line screening tools in resource-limited settings, but their concordance with nerve conduction study (NCS), the electrophysiological reference standard, is uncertain and may vary by population. Aim: To compare the diagnostic performance of bedside clinical methods (vibration perception by tuning fork, Semmes-Weinstein monofilament testing, and ankle reflex) against NCS for detecting diabetic neuropathy in patients with T2DM in a Western Maharashtra population. Materials and Methods: This descriptive, cross-sectional pilot study enrolled 14 patients with T2DM. Each patient underwent a structured clinical neurological examination (vibration perception, monofilament testing, ankle reflex) and NCS (motor and sensory conduction of an upper- or lower-limb nerve). Findings from clinical examination were compared against NCS, which was used as the reference standard. Descriptive statistics were used given the small sample size. Results: The mean age was 52.1 ± 15.4 years and mean duration of diabetes was 9.1 ± 4.7 years; mean HbA1c was 9.3 ± 1.9%. NCS was abnormal in 11 of 14 patients (78.6%) — mixed pattern in 5, axonal in 4, and demyelinating in 2 — while 3 patients (21.4%) had entirely normal nerve conduction. In contrast, bedside clinical examination detected an abnormality in only 5 of 14 patients (35.7%). Using NCS as the reference standard, clinical examination showed a sensitivity of 45.5%, a specificity of 100%, and an overall concordance of 57.1%. Abnormal NCS was seen in 5 of 6 patients (83.3%) with diabetes duration ≥10 years and in 6 of 8 patients (75.0%) with shorter duration, suggesting a modest but non-absolute association between longer disease duration and electrophysiological neuropathy in this small cohort. Conclusion: In this small pilot cohort, bedside clinical tests substantially under-detected diabetic neuropathy compared with NCS, consistent with prior literature describing low sensitivity of clinical examination for subclinical DPN. These preliminary findings support incorporating NCS or more sensitive quantitative screening tools where feasible, and warrant confirmation in a larger, adequately powered study.
References
Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010; 33(10):2285-2293.https://doi.org/10.2337/dc10-1303
2. Pop-Busui R, Boulton AJM, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care. 2017; 40(1):136-154. https://doi.org/10.2337/dc16-2042
3. Jende JME, Kender Z, Heiland S, Kopf S, Bendszus M, Pham M. The global burden of diabetic peripheral neuropathy: Improving clinical and research practice. Front Endocrinol (Lausanne). 2024; 15:1452832.
4. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Res Clin Pract. 2019; 157:107843. https://doi.org/10.1016/j. diabres.2019.107843
5. International Diabetes Federation. IDF Diabetes Atlas. 10th Edition. Brussels: International Diabetes Federation. 2021.
6. Sun H, Saeedi P, Karuranga S, Pinkepank M, Ogurtsova K, Duncan BB, et al. IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Res Clin Pract. 2022; 183:109119. https://doi.org/10.1016/j.diabres.2021.109119.
7. Prevalence and its associated determinants of diabetic peripheral neuropathy in central India. Indian J Endocrinol Metab. 2022; 26(Suppl 1).
8. Shah M, Vasoya N, Shukla V, Soni A, Modi N. Burden and geographical variation of peripheral neuropathy in India: Insights from a large multi-regional screening study. Int J Basic Clin Pharmacol. 2026; 15(2):258-262. https://doi.org/10.18203/2319-2003.ijbcp20260336
9. Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Prevalence and risk factors of diabetic peripheral neuropathy in South Asian type 2 diabetes patients: A systematic review and meta-analysis. J Diabetes Investig. 2014; 5(6):728-34. https://doi.org/10.1111/jdi.12223
10. Peripheral neuropathy in diabetes mellitus. Curr Diab Rep. 2023; 23(2):45-58.
11. Dyck PJ, Tomlinson DR, Veves A, Malik RA. Nerve conduction studies and quantitative sensory testing in diabetic neuropathy: Complementary roles. Diabet Med. 2005; 22(7):913-919.
12. Papanas N, Ziegler D. Nerve conduction studies in diabetic peripheral neuropathy: clinical implications and assessment of treatment response. Diabetes Metab Res Rev. 2011; 27(7):654-660.
13. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK, Carter GT, et al. Practice parameter: Evaluation of distal symmetric polyneuropathy: Role of nerve conduction studies and skin biopsy. Neurology. 2009; 72(2):177-184. https://doi.org/10.1212/01.wnl.0000336345.70511.0f
14. Diabetic peripheral neuropathy: Pathogenetic mechanisms and current diagnostic approach. J Diabetes Complications. 2024; 38(1):108-118.
15. Spallone V, Morganti R, D’Amato C, Greco C. Validity of clinical and bedside tests for detecting diabetic peripheral neuropathy. J Neurol Sci. 2011; 310(1-2):64-68.
16. Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, et al. Assessing neuropathy in people with diabetes: A review of clinical tests. Diabetes Metab Res Rev. 2017; 33(9).
17. Ikbal M, Mishra S, Agrawal S, Jain A, Mehta A. Correlation of glycaemic variability, HbA1c and nerve conduction study in patients with type 2 diabetes mellitus attending a tertiary care hospital in Kolhapur, Maharashtra, Nashik: Maharashtra University of Health Sciences. 2019.
18. Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, et al. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: A systematic review and meta-analysis. J Diabetes Res. 2017; 2017:8787261. https://doi.org/10.1155/2017/8787261
19. Al-Geffari M. Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in primary health care setting. Int J Health Sci (Qassim). 2012; 6(2):127-34. https://doi.org/10.12816/0005988
20. Moghtaderi A, Bakhshipour A, Rashidi H. Validation of Michigan Neuropathy Screening Instrument for diabetic peripheral neuropathy. Clin Neurol Neurosurg. 2006; 108(5):477-481. https://doi.org/10.1016/j.clineuro.2005.08.003
21. Jayaprakash P, Bhansali A, Bhansali S, Dutta P, Anantharaman R, Shanmugasundar G, et al. Validation of bedside methods in evaluation of diabetic peripheral neuropathy. Indian J Med Res.
22. Perkins BA, Zinman B, Olaleye D, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001; 24(2):250-256. https://doi.org/10.2337/diacare.24.2.250
23. Liu F, Bao Y, Hu R, Zhang X, Li H, Zhu D, et al. Screening and prevalence of peripheral neuropathy in type 2 diabetic outpatients: a randomized multicentre survey in 12 city hospitals of China. Diabetes Metab Res Rev. 2010; 26(6):481-489. https://doi.org/10.1002/dmrr.1107
24. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994; 17(11):1281-1289. https://doi.org/10.2337/diacare.17.11.1281
25. Viswanathan V, Khan BA, Nachimuthu S, Kumpatla S. Precision of Michigan Neuropathy Screening Instrument tool for the diagnosis of diabetic peripheral neuropathy among people with type 2 diabetes: a study from South India. Int J Low Extrem Wounds. 2023. https://doi.org/10.1177/15347346231163209
26. International Diabetes Federation. IDF Diabetes Atlas. 11th Edition. Brussels: International Diabetes Federation. 2025.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Dhumal Jairaj Sanjay , Ganvir Shyam, Ganvir Suvarna, Shaikh Jasmine, Waran Marcia, Shrivastava A.K
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
