Main Article Content
Aims: To determine the accuracy of the Filipino version of the Michigan Neuropathy Screening Instrument (MNSI) in detecting distal symmetric peripheral neuropathy (DSPN) among diabetic patients, by comparing it to electromyography-nerve conduction velocity (EMG-NCV) as a gold standard.
Study Design: Cross-sectional study.
Place and Duration of the Study: Out-patient Department, University of the East Ramon Magsaysay Memorial Medical Center Inc., Philippines; From May 2016 to March 2017.
Methodology: Researchers tested 103 patients with Type 2 diabetes mellitus in the out-patient clinic of a single-centre tertiary hospital and determined the sensitivity and specificity of the Filipino version of the MNSI in identifying DSPN by comparing it to the EMG-NCV as a gold standard. Risk factors for neuropathy were also identified.
Results: The sensitivity of the combined Filipino MNSI questionnaire and clinical examination tool was 74.7%, and a specificity of 25%. The MNSI questionnaire scores had a statistically significant correlation to the degree of neuropathy as measured by the EMG-NCV (P= .01). There was no statistically significant difference between those with and without DSPN in terms of BMI, history of smoking, duration of diabetes, level of glycaemic control or presence of hypertension.
Conclusion: The Filipino MNSI may be used as a screening tool for distal symmetric peripheral neuropathy among diabetic patients due to its high sensitivity (74.7%). A positive Filipino MNSI will signal the need for further investigation using the EMG-NCV. The MNSI can be performed easily by a healthcare worker in the clinic to screen diabetic patients for neuropathy, and to monitor disease severity, preventing its complications.
(Accessed 31 May 2015)
Deli G, Bosnyak E, Pusch G, Komoly S, Feher G. Diabetic neuropathies: Diagnosis and management. Neuroendocrinology. 2013;98:267-80.
Cardino MJ, Josol C, Isip-Tan I, Jimeno C. Risk factors for major amputation of diabetic foot ulcers. Phil J of Int Med. 2011; 49(2):75-78.
Boulton A. Management of diabetic peripheral neuropathy. Clin Diab. 2005; 23(1):9-15.
Boulton A, Vinik A, Arezzo J, et al. Diabetic neuropathies: A statement by the American Diabetes Association. Diab Care. 2005;28(4):956-62.
Lunetta M, Le Moli R, Grasso G, Sangiorgio L. A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy. Diab Res and Clin Prac. 1998;39:165-72.
Jimeno C, Abad L, Andag-Silva A, et al. UNITE for diabetes Philippines. Philippine practice guidelines on the Diagnosis and Management of Diabetes Mellitus. Compendium of Philippine Medicine; 2014.
(Accessed 17 March 2015)
Herman WH, Pop-Busui R, Braffett BH, et al. Use of the michigan neuropathy screening instrument as a measure of distal symmetrical peripheral neuropathy in type 1 diabetes: Results from the diabetes control and complications trial/ epidemiology of diabetes interventions and complications. Diabet Med. 2012;29(7): 937-44.
Dunnigan SK, et al. Conduction slowing in diabetic sensorimotor polyneuropathy. Diabetes Care. 2013;36(11):3684-90.
Kong X, Lesser E, Potts F, Gozani S. Utilization of nerve conduction studies for the diagnosis of polyneuropathy in patients with diabetes: A retrospective analysis of a large patient series. J Diabetes Sci Technol. 2008;2(1):268-74.
Baba M, Suzuki C, Tomiyama M. Five-year prospective study on development of diabetic foot with a severity staging system of diabetic neuropathy by nerve conduction study. Journal of the Neurological Sciences; 2017.
Mete T, Aydin Y, Saka M, et al. Comparison of efficiencies of michigan neuropathy screening instrument, neurothesiometer, and electromyography for diagnosis of diabetic neuropathy. Int J of Endocrinology; 2013.
(Accessed 11 July 2016)
Al-Geffari M. Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting. International Journal of Health Sciences. 2012;6:2,109-115.
Feldman E, 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. Diab Care. 1994;17(11):1281-89.
American Diabetes Association. Standards of Medical Care in Diabetes. Diab Care. 2015;38:1.
Dyck PJ, Karnes JL, O’Brien PC, Litchy WJ, Low PA, Melton LJ. The rochester diabetic neuropathy study: Reassessment of tests and criteria for diagnosis and staged severity. Neurology. 1992;42:6.