About Diabetes
Complications
Warning Signs
Screening Test
Donate Now
E-Lerts™
Index
Latest News
Diabetes Terms
Health & Fitness
Online Press Center
Glucose Tolerance Test & B12 Levels Best to Diagnose
Sensory Neuropathy
posted 05/19/04
Patients with sensory neuropathy should be evaluated with a
glucose tolerance test and vitamin B12 levels.
"Peripheral neuropathy is a common problem that often prompts a lengthy and
expensive diagnostic evaluation," write A. Gordon Smith, MD, and J. Robinson
Singleton, MD, from the University of Utah School of Medicine in Salt Lake City.
"A rational, evidence-based diagnostic approach to peripheral neuropathy is
desirable.... The goal was to develop a focused diagnostic algorithm that can be
easily applied in a general medical setting."
Using a standard diagnostic approach, the authors evaluated 138 patients
referred with predominantly sensory symptoms and no previously defined etiology
for neuropathy.
Family history was positive in 25% of patients, with at least one first-degree
relative with symptoms suggesting neuropathy. The two-hour oral glucose
tolerance test (OGTT) had the highest diagnostic yield (61%) of all laboratory
tests and was more sensitive than other measures of glucose metabolism. Two
patients were diagnosed with vitamin B12 deficiency.
Based on these findings, the authors suggest that patients with
sensory-predominant neuropathy should be tested for glucose tolerance and
vitamin B12 level, that abnormalities of serum protein electrophoresis and
antinuclear antibodies are of uncertain significance, and that other tests
should be performed only when the clinical scenario is suggestive.
"Using this approach, only 31% of patients completing the recommended evaluation
were found to have an idiopathic neuropathy," the authors write. "Patients with
atypical features may benefit from referral to a peripheral neuropathy center."
Since the manuscript was accepted for publication, the American Diabetes
Association (ADA) revised its criterion for impaired fasting glucose (IFG) as
ranging from 100 to 125 mg/dL (5.6 - 6.9 mmol/L). Of an additional 12 patients
with IFG using the new criterion, seven had impaired glucose tolerance (IGT) and
two had diabetes on the basis of the two-hour plasma glucose test during an OGTT.
"The revised criterion has not substantially altered the diagnostic yield of the
fasting plasma glucose test (either alone or as part of the OGTT) in this
patient population," the authors write.
From the results of the study, it was concluded that routine use of OGTT is
recommended to screen patients presenting with sensory-predominant neuropathy.
Also, routine measurement of vitamin B12 levels is warranted, and those with
borderline levels should have serum concentrations of methylmalonic acid and
homocysteine measured.
Source: Diabetes In Control.com: Arch Intern Med. 2004;164:1021-1025.
|
|
|
To be sure and come back to keep up with all the
Latest News and important information for diabetics - and to remind
yourself to manage and control your diabetes, click the yellow link
below
to add a small icon of our Defeat Diabetes® "Torch"
logo to your desktop. All you need to do after that is
click on the "Torch" to open our website.
Remember, we're here for you!
Translate this page into Spanish using FreeTranslation.com. © Copyright 2001 - 2004, Defeat Diabetes Foundation, Inc., All Rights Reserved |
We
subscribe to the HONcode principles