Threshold for detecting neuropathy with monofilaments

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Threshold for detection of diabetic peripheral sensory neuropathy using a range of research grade monofilaments in persons with Type 2 diabetes mellitus

Mary P Thomson , Julia Potter , Paul M Finch and Richard B Paisey

Journal of Foot and Ankle Research 2008, 1:9doi:10.1186/1757-1146-1-9

Published: 11 September 2008

Abstract (provisional)

Background
Type 2 diabetes mellitus is a chronic metabolic disorder that is becoming more common both nationally and globally. The National Service framework for Diabetes in 2001 states that foot ulceration and lower limb amputation can be reduced if vulnerable feet are identified promptly. This study was designed to identify the threshold at which it is clinically feasible to detect reduced sensory perception in Type 2 diabetes mellitus using a range of research grade monofilaments.

Methods
Three groups of participants were recruited into a between subject, cross-sectional study. Group 1 (NEW), persons with Type 2 DM diagnosed for less than 2 years (n = 80); Group 2 (EST) persons with Type 2 DM diagnosed for more than 2 years (n = 91), and Group 3, a Comparison group without Type 2 DM (n = 73), resulting in a total study population, n = 244. Research grade monofilaments (2, 4, 6, 8 and 10-gramme) were employed using standardised protocol, at 6 sites on the plantar aspect of both feet. The demographic and anthropometric measures of the participants of each group were analysed.

Results
Perception of the research grade monofilaments differed significantly between the 3 groups (p<0.05). The 6-gramme monofilament was found to be the threshold of normal perception, based on 90% of the Comparison group perceiving the 6-gramme monofilament at all sites, in contrast to 64% of NEW and 48% of EST groups.

Conclusions
The 6-gramme monofilament was identified as the threshold of normal sensory perception. Employing a range of monofilaments, 6, 8 and 10-grammes in Type 2 DM foot screening would enable the clinical detection of deteriorating sensory perception and implementation of foot protection strategies at an earlier stage than is currently practised.

 

This conclusion is entirely predictable. Indeed, I am prepared to forecast that a 0.5 gm monofilament will predict much the same even earlier!

Is Julia Potter related to Mike Potter - Editor in Chief of this publication?

 

Mr & Mrs