St. Johns Medical College Hospital, Sarjapur Road, Bangalore, 560034, India.
Department of Endocrinology, St. Johns Medical College Hospital, Sarjapur Road, Bangalore, 560034, India.
Diabetes Metab Syndr. 2021 May-Jun;15(3):857-862. doi: 10.1016/j.dsx.2021.03.023. Epub 2021 Apr 7.
Diabetic foot ulcer (DFU) is a debilitating complication of type 2 DM. Complexity of foot examination often precludes proper clinical assessment of the foot during routine evaluation. We assessed the utility of novel device, vibratip, both singly and in combination with standard bedside tools for assessment of loss of protective sensation.
75 patients admitted with DFU were included in the study. Clinical examination of the contralateral foot was done - temperature perception, vibration, pinprick sensation, Achilles tendon reflex and Neuropathy disability score were assessed. Testing using 10 g Monofilament, Vibratip and biothesiometer were also done. Considering the biothesiometer as the reference standard, three bedside tests (Vibratip, 10 g monofilament and 128 Hz tuning fork) were compared against it singly and in combinations.
When compared against biothesiometer, vibratip performed significantly well with a positive predictive value of 90.3% and specificity of 84.2%. Sensitivity, however, was only 50%. On combining bedside tests, the best combination strategy was seen with vibratip and 10 g monofilament, which improved the sensitivity to 62.5%. Combining all three bedside tests further improved sensitivity to 64.3%.
All the patients with an at-risk foot may not be identified with vibratip alone. Nevertheless, an abnormal result is almost always associated with loss of protective sensation, and such persons should be suitably educated.
Due to small size of the study population, it is not possible to generalize the findings to all patients with diabetes mellitus. A larger study would be required to provide more confirmatory findings.
糖尿病足溃疡（DFU）是 2 型糖尿病的一种严重并发症。足部检查的复杂性通常使得在常规评估中无法对足部进行适当的临床评估。我们评估了新型设备 Vibratip 的效用，单独使用和与标准床边工具结合使用来评估保护性感觉丧失。
纳入了 75 例因 DFU 入院的患者。对其对侧足部进行临床检查，评估温度感知、振动、刺痛感、跟腱反射和神经病变残疾评分。还进行了 10g 单丝、Vibratip 和生物感觉计的测试。考虑到生物感觉计作为参考标准，我们将三种床边测试（Vibratip、10g 单丝和 128Hz 音叉）单独和组合使用与生物感觉计进行比较。
与生物感觉计相比，Vibratip 的表现明显更好，阳性预测值为 90.3%，特异性为 84.2%。然而，敏感性仅为 50%。在结合床边测试时，Vibratip 和 10g 单丝的最佳组合策略显示敏感性提高到 62.5%。结合所有三种床边测试，敏感性进一步提高到 64.3%。
并非所有有风险的足部患者都可以仅用 Vibratip 识别。然而，异常结果几乎总是与保护性感觉丧失相关，此类患者应接受适当的教育。
由于研究人群规模较小，因此无法将研究结果推广到所有糖尿病患者。需要更大规模的研究来提供更确定的发现。
