Commentary

Peripheral neuropathy is a common and troublesome complication of diabetes mellitus. It increases the risk for diabetic foot disease, which accounts for more hospital bed occupancy than any other specific diabetic complication. If neuropathy is detected, closer monitoring and educational and therapeutic interventions can delay or prevent ulcers and amputations. Unfortunately, many of the growing number of people with diabetes are not being screened regularly for neuropathy. This situation might be improved if quick and simple screening tests were readily available in primary care, where most patients are now routinely reviewed.

Screening tests should be evaluated against a recognised diagnostic standard in the population in which the test is to be used by researchers blinded to the diagnostic test results. In this study by Franse et al, a symptom questionnaire was tested against a clinical examination that had been previously validated against neurophysiological examination, albeit not in a community sample. The results were disappointing. Although symptoms were associated with examination findings, sensitivities for detection of neuropathy were <30%, and the authors concluded that the questionnaire should not replace annual examination by the general practitioner. Other researchers have suggested that symptom scores may be useful when combined with a limited screening examination.¹ However, as monofilaments for testing sensation are now widely available, inexpensive, and easily administered by any trained practitioner,² perhaps the need for a questionnaire to stratify the population and target examination by general practitioners is diminished.