Mogilevskaya María, Gaviria-Carrillo Mariana, Feliciano-Alfonso John Edwin, Barragan Ana M, Calderon-Ospina Carlos A, Nava-Mesa Mauricio O
Neuroscience Research Group (NeURos), Neurovitae-UR Neuroscience Center, Institute of Translational Medicine (IMT), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá 111221, Colombia.
Internal Medicine Department, School of Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia.
J Diabetes Res. 2024 Dec 4;2024:5902036. doi: 10.1155/jdr/5902036. eCollection 2024.
Peripheral neuropathy is a common cause of morbidity in diabetes. Despite recent advancements in early diagnosis methods, there is a need for practical, highly sensitive, and cost-effective screening methods in clinical practice. This study summarizes evidence from systematic reviews and meta-analyses on the diagnostic accuracy of validated screening methods for diabetic peripheral neuropathy. Two independent reviewers assessed methodological quality and bias using AMSTAR and ROBIS tools. Seven reviews with 19,531 participants were included. The monofilament test showed inconsistent sensitivity (: 0.53-0.93) and specificity (Sp: 0.64-1.00), along with high variability in its application. Neuropad exhibited high (86%, 95% CI 79-91). However, variations in the interpretation of results across the included studies may have impacted its Sp (65%, 95% CI 51-76). The Ipswich touch test exhibited adequate diagnostic accuracy (: 0.77, Sp: 0.96, DOR: 75.24) but lacked comparison with gold standard tests. In vibration perception studies, the biothesiometer outperformed the tuning fork (: 0.61-0.80 vs. 0.10-0.46). In general, heterogeneity was observed due to varied reference tests, thresholds, and patient differences. The development of automated analysis methods, as well as determination of predictive value of the combination of screening tools, is needed for further studies. Based on the study results, we suggest that clinicians should select screening tools tailored to their patient population, clinical setting, and available resources, as no single test can be universally recommended for all clinical scenarios.
周围神经病变是糖尿病常见的发病原因。尽管早期诊断方法最近有所进展，但临床实践中仍需要实用、高灵敏度且具有成本效益的筛查方法。本研究总结了系统评价和荟萃分析中关于糖尿病周围神经病变有效筛查方法诊断准确性的证据。两名独立评审员使用AMSTAR和ROBIS工具评估方法学质量和偏倚。纳入了7项综述，共19531名参与者。单丝试验的敏感性（Se：0.53 - 0.93）和特异性（Sp：0.64 - 1.00）不一致，其应用的变异性也很高。神经垫的敏感性较高（86%，95%CI 79 - 91）。然而，纳入研究中结果解释的差异可能影响了其特异性（65%，95%CI 51 - 76）。伊普斯威奇触觉试验显示出足够的诊断准确性（Se：0.77，Sp：0.96，DOR：75.24），但缺乏与金标准试验的比较。在振动觉研究中，生物感觉阈值测量仪的表现优于音叉（Se：0.61 - 0.80 vs. 0.10 - 0.46）。总体而言，由于参考试验、阈值和患者差异的不同，观察到了异质性。进一步的研究需要开发自动化分析方法，以及确定筛查工具组合的预测价值。基于研究结果，我们建议临床医生应根据患者群体、临床环境和可用资源选择合适的筛查工具，因为没有单一的测试可以普遍推荐用于所有临床情况。
