Department of Clinical Sciences, Endocrinology, Lund University, Malmö, Sweden.
Department of Clinical Sciences, Endocrinology, Lund University, Lund, Sweden.
PLoS One. 2019 Feb 28;14(2):e0212921. doi: 10.1371/journal.pone.0212921. eCollection 2019.
To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.
VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).
The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.
Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers.
研究多频振动感觉阈值（VPT）测量是否可识别发生糖尿病足溃疡或神经病变症状风险较高的个体。
在 535 例 1 型糖尿病（T1DM）患者和 717 例非糖尿病对照者的足底第一和第五跖骨头，使用标准的 VibroSense Meter 设备，分别在 6 个不同频率（4、8、16、32、64 和 125Hz）上测量 VPT。采用对照组的 VPT 值，为男性和女性各 5 个不同年龄组分别建立正常范围。正常范围定义为每个组的平均值加 1.66 x 标准差以下的 VPT。通过测试各种异常 VPT 定义，包括所有频率、仅最低 VPT 频率（4 和 8Hz）或仅最高 VPT 频率（64 和 125Hz）。
与年龄和性别匹配的非糖尿病对照组相比，T1DM 患者的 VPT 更高。低频（4 和 8Hz）尤其与糖尿病足溃疡的风险相关（OR 40.7[5.4-308.4]，p = 0.0003），与平衡或步态困难（OR 1.89[1.04-3.46]，p = 0.04）、感觉障碍（OR 2.77[1.25-6.16]，p = 0.01）相关。与年龄和性别匹配的对照组相比，短期（≤10 年）T1DM 患者的 125Hz 频率 VPT 更高。
低频 VPT 似乎是发生糖尿病足溃疡、步态或平衡问题或足部无力风险的更好指标。然而，125Hz 频率似乎较早受损，且它是糖尿病病程较短患者中唯一的病理性 VPT 频率。本研究提示，为了全面评估糖尿病神经病变和糖尿病足溃疡的危险因素，至少应包括 4 个不同频率（4、8、64 和 125Hz）的检查。
