Feldman E L, Stevens M J
Department of Neurology, University of Michigan, Ann Arbor.
Can J Neurol Sci. 1994 Nov;21(4):S3-7. doi: 10.1017/s0317167100040671.
Diabetic polyneuropathy is a complex disease of progressive nerve fiber loss. Initial screening and diagnosis in clinical practice usually depend on assessment of subjective complaints. A need exists for objective, simple, and reproducible assessment tools that can be readily used in clinical practice. The importance of early diagnosis is highlighted by the recent North American Diabetes Control and Complications Trial where intensive insulin therapy reduced the risk of developing diabetic neuropathy by 61%. At the University of Michigan, we have developed an outpatient neuropathy program. Patients are given a questionnaire and a brief screening examination, designated the Neuropathy Screening Instrument. Diabetic neuropathy is confirmed and staged in patients with a positive Neuropathy Screening Instrument, by a quantitative neurologic examination and nerve conduction studies, designated the Diabetic Neuropathy Score. The Michigan program has been compared with well-established instruments and has been found to be sensitive and reproducible for screening and diagnosis. We believe the program provides a valuable tool for the clinician in the practice setting and should allow diagnosis and intervention earlier in the course of diabetic neuropathy.
糖尿病性多发性神经病是一种神经纤维进行性丧失的复杂疾病。临床实践中的初步筛查和诊断通常依赖于对主观症状的评估。需要有客观、简单且可重复的评估工具，以便能在临床实践中轻松使用。近期的北美糖尿病控制与并发症试验强调了早期诊断的重要性，该试验中强化胰岛素治疗使糖尿病性神经病的发病风险降低了61%。在密歇根大学，我们开发了一个门诊神经病项目。给患者一份问卷和一次简短的筛查检查，即神经病变筛查工具。对于神经病变筛查工具呈阳性的患者，通过定量神经学检查和神经传导研究（即糖尿病性神经病评分）来确诊糖尿病性神经病并进行分期。密歇根项目已与成熟的工具进行了比较，结果发现它在筛查和诊断方面具有敏感性和可重复性。我们认为该项目为临床实践中的医生提供了一个有价值的工具，并且应该能够在糖尿病性神经病病程的早期实现诊断和干预。
