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首页> 外文期刊>Diabetic medicine: A journal of the British Diabetic Association >One‐stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high‐risk foot
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One‐stop microvascular screening service: an effective model for the early detection of diabetic peripheral neuropathy and the high‐risk foot

机译：一站式微血管筛选服务：早期检测糖尿病外周神经病变和高风险脚的有效模型

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Abstract Aims To evaluate the feasibility of a one‐stop microvascular screening service for the early diagnosis of diabetic distal symmetrical polyneuropathy, painful distal symmetrical polyneuropathy and the at‐risk diabetic foot. Methods People with diabetes attending retinal screening in hospital and community settings had their feet examined by a podiatrist. Assessment included: Toronto Clinical Neuropathy Score evaluation; a 10‐g monofilament test; and two validated, objective and quick measures of neuropathy obtained using the point‐of‐care devices ‘ DPN ‐Check’, a hand‐held device that measures sural nerve conduction velocity and amplitude, and ‘Sudoscan’, a device that measures sudomotor function. The diagnostic utility of these devices was assessed against the Toronto Clinical Neuropathy Score as the ‘gold standard’. Results A total of 236 consecutive people attending the retinal screening service, 18.9% of whom had never previously had their feet examined, were evaluated. The prevalence of distal symmetrical polyneuropathy, assessed using the Toronto Clinical Neuropathy Score, was 30.9%, and was underestimated by 10‐g monofilament test (14.4%). The prevalence of distal symmetrical polyneuropathy using DPN ‐check was 51.5% (84.3% sensitivity, 68.3% specificity), 38.2% using Sudoscan foot electrochemical skin conductance (77.4% sensitivity, 68.3% specificity), and 61.9% using abnormality in either of the results (93.2% sensitivity, 52.8% specificity). The results of both devices correlated with Toronto Clinical Neuropathy Score ( P 0.001). A new diagnosis of painful distal symmetrical polyneuropathy was made in 59 participants (25%), and 56.6% had moderate‐ or high‐risk foot. Participants rated the service very highly. Conclusions Combined, eye, foot and renal screening is feasible, has a high uptake, reduces clinic visits, and identifies painful distal symmetrical polyneuropathy and the at‐risk foot. Combined large‐ and small‐nerve‐fibre assessment using non‐invasive, quantitative and quick point‐of‐care devices may be an effective model for the early diagnosis of distal symmetrical polyneuropathy.
机译：摘要旨在评估一站式微血管筛查服务的可行性，以便早期诊断糖尿病远端对称多肌病，疼痛远端对称多变病变和风险型糖尿病脚。方法在医院和社区环境中参加视网膜筛查的糖尿病的人们都有脚尖检查。评估包括：多伦多临床神经病变评分评估; 10g单丝测试;和使用Point-Pock-Check'，使用衡量SUDOMotor函数的设备的手持装置。根据“黄金标准”，评估这些设备的诊断效用作为多伦多临床神经病变评分。结果总共236人参加视网膜筛查服务，其中18.9％从未检查过他们的脚，均被检查。使用多伦多临床神经病评分评估远端对称性多变疗法的患病率为30.9％，低估了10g单丝试验（14.4％）。使用DPN的远端对称多变病变的患病率为51.5％（敏感性84.3％，特异性68.3％），38.2％，使用SmoScan脚电化学皮肤电导（77.4％的敏感性，68.3％的特异性）和61.9％使用异常结果（93.2％敏感性，特异性52.8％）。两种器件的结果与多伦多临床神经病变得分相关（P <0.001）。在59名参与者（25％）中制造了新的痛苦远端对称多变病变，56.6％具有中等或高风险的脚。参与者非常高度评价服务。结论结合，眼睛，脚和肾脏筛查是可行的，具有高吸收，降低临床访问，并识别疼痛的远端对称性多变病变和危险的脚。使用非侵入性，定量和快速护理点装置组合大型和小神经纤维评估可以是远端对称性多变病变的早期诊断的有效模型。

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