Diagnosing diabetic peripheral neuropathies in pediatric practice: An in-place validation of a mechanical detection test

• Applicant: Professor Dr. Gerrit Hirschfeld
• Subject Area: Pediatric and Adolescent Medicine
• Term: from 2012 to 2015
• Project identifier: Deutsche Forschungsgemeinschaft (DFG) - Project number 228897357

Diabetes Mellitus is the most prevalent metabolic disease in childhood and adolescence. Diabetic peripheral neuropathies, even though they themselves may be painless, are an important risk-factor for the development of severely disabling complications (foot ulcerations and amputations) and thus have to be closely monitored.Nerve-conduction studies are objective tests for peripheral neuropathies and show that between 25% and 59% of the children with diabetes have peripheral neuropathies. However Nerve-conduction-studies are unpleasant and are not available in every practice. For adults the Rydell-Seiffer tuning-fork test and the 10-g Semmes-Weinstein monofilament test have been proven useful in screening for peripheral neuropathies. The former tests the vibration perception threshold, by placing a vibrating tuning fork on a bony prominence and patients have to indicate when they cannot feel the vibration any more. The latter tests touch perception by a applying a defined force to the skin using a monofilament that bends at a specific force. These screening methods are also recommended for use in children by the current German S3 guidelines for treatment of children with diabetes mellitus. Studies in children and adolescents however indicate that neither are useful screeningtests in this group. While there are no practicable alternatives to the tuning fork, a recent study suggests, that the monofilament test may be improved by using more sensitive monofilaments. For example the currently used 10g monofilament exerts a force of 100 milliNewton, which is about 100 times stronger than the detection threshold of healthy children. A valid comparison of such a novel more sensitive monofilament test is still lacking.The aim of the proposed study is to compare the diagnostic utility of the novel monofilament test with the currently used tuning-fork in pediatric practice.

• DFG Programme: Research Grants