Distal symmetrical polyneuropathy in diabetes mellitus patients: Proposition of a new scoring system based on electroneurography findings.

Background: Neuropathy affects 25% of people with diabetes mellitus. The evaluation of disease severity is still a challenge for modern medicine. Many screening instruments are based primarily on clinical criteria. There is a lack of a simple, reliable and precise scoring system that could improve the classification of neuropathy and monitor disease progression using not only clinical criteria but also electroneurography. There is a need to find sensitive neurography parameters that reflect peripheral nerve impairments in this group of patients.

Objectives: This study aimed to create a scoring system for diabetic neuropathy, based on electroneurography criteria, that reflects the natural course of the disease. A new scoring system will improve the treatment of patients with diabetes mellitus.

Material and methods: A total of 113 patients with distal symmetrical polyneuropathy (DSPN) were involved in the study. Median, ulnar, sural, tibial, and peroneal nerves were examined. Parameters such as amplitude, conduction velocity, distal latency, and F wave latency were analyzed. The results of nerve conduction studies in the investigated group were compared to those of the control group, which consisted of 61 healthy volunteers.

Results: The most sensitive parameter of peripheral nerve impairment severity was a reduction of the sensory action potential amplitude in the peroneal nerve by 72.8% (p < 0.05). The observation of changes in sensory action potential amplitudes in the peroneal nerve is the most important element of our scoring system.

Conclusions: A new electroneurography scoring system of DSPN severity should be based on sensory and motor action potential amplitudes that reflect axonal loss in the examined nerves and the nature of the disease.