DIAGNOSTIC ACCURACY OF CLINICAL SCORING SYSTEMS (NSS, NDS, AND TCSS) COMPARED TO ELECTROPHYSIOLOGICAL TESTING IN DIABETIC NEUROPATHY AMONG T2DM PATIENTS
Main Article Content
Keywords:
Diabetic Neuropathy, NSS, NDS, TCSS, Nerve Conduction StudyAbstract
Diabetic neuropathy is one of the most common chronic complications in diabetes mellitus patients and can significantly impair quality of life. Early diagnosis is essential, but limited availability of diagnostic tools such as electrophysiological testing in many healthcare facilities calls for more practical and efficient alternatives. This study aimed to compare the diagnostic accuracy of three clinical scoring systems—NSS (Neuropathy Symptom Score), NDS (Neuropathy Disability Score), and TCSS (Toronto Clinical Scoring System)—in detecting diabetic neuropathy among Type 2 DM patients at Dr. Mohammad Hoesin Hospital, Palembang. A cross-sectional design was employed, and findings revealed that TCSS had the highest accuracy (90.3%) compared to NDS (85.5%) and NSS (85.4%). TCSS also demonstrated the best balance of sensitivity (95.4%) and specificity (77.8%). All three instruments can serve as effective early screening tools, especially in healthcare settings with limited access to electrophysiological diagnostic facilities.
Article Details
References
Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Vol. 5, Nature Reviews Disease Primers. Nature Publishing Group; 2019.
Zhu J, Hu Z, Luo Y, Liu Y, Luo W, Du X, et al. Diabetic peripheral neuropathy: pathogenetic mechanisms and treatment. Front Endocrinol (Lausanne) [Internet]. 2024 Jan 9 [cited 2024 Jul 28];14. Available from: [https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1265372/full](https://www.frontiersin.org/journals/endocrinology/articles/10.3389/fendo.2023.1265372/full)
Yu Y. Gold Standard for Diagnosis of DPN. Front Endocrinol (Lausanne). 2021 Oct 26;12.
Asmedi A, Nuradyo D, PKU Muhammadiyah Yogyakarta R, Neurologi B, Kedokteran UGM Yogyakarta F. Neuropathy Symptom Score dan Neuropathy Defi cit Score sebagai skor diagnostik neuropati diabetik Neuropathy Symptom Score and Neuropathy Defi cit Score as Diagnostic Score of Diabetic Neuropathy. Vol. 15, Berkala Neurosains. 2016.
Oh J. Clinical spectrum and diagnosis of diabetic neuropathies. Vol. 35, Korean Journal of Internal Medicine. Korean Association of Internal Medicine; 2020. p. 1059–69.
Yang H, Sloan G, Ye Y, Wang S, Duan B, Tesfaye S, et al. New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine. Vol. 10, Frontiers in Endocrinology. Frontiers Media S.A.; 2020.
Mardastuti Y, Asmedi A, Gofi A, Margono Soekarjo R, Neurologi B, Kedokteran UGM F. Diabetic Neuropathy Symptom-versi Indonesia dan. Berkala Neurosains. 2016;15(2).
Kamel SR, Hamdy M, Abo Omar HAS, Kamal A, Ali LH, Abd Elkarim AH. Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies. Egyptian Rheumatology and Rehabilitation. 2015 Jul;42(3):128–36.
Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy. Vol. 12, Frontiers in Endocrinology. Frontiers Media S.A.; 2021.
Basuki M, Hamdan M, - F, - F, - N. Toronto Clinical Neuropathy Score and Modified Toronto Clinical Neuropathy Score Diagnostic Tests in Distal Diabetic Sensorimotor Polyneuropathy Patients. International Journal of Psychosocial Rehabilitation. 2020 Feb 13;24(02):4188–97.
Purbasari B, Anggraini VL, Pratiwi MD, Husna M, Kurniawan SN. Diagnostic Test of Toronto And Modified Toronto Scoring, Monofilament Test Using 128 Hz Tuning Fork For Diabetic Polineuropathy. MNJ (Malang Neurology Journal). 2018 Jan 1;4(1):25–34.
Mohan G, Chandey M, Monga A, Dev P. Comparative study of detection of diabetic neuropathy by clinical and nerve conduction study in type 2 diabetes mellitus patients. International Journal of Advances in Medicine. 2018 Mar 21;5(2):380.
Afifi L, Abdelalim AM, Ashour AS, Al-Athwari A. Correlation between clinical neuropathy scores and nerve conduction studies in patients with diabetic peripheral neuropathy. Egyptian Journal of Neurology, Psychiatry and Neurosurgery. 2016 Oct 1;53(4):248–52.
Kamel SR, Hamdy M, Abo Omar HAS, Kamal A, Ali LH, Abd Elkarim AH. Clinical diagnosis of distal diabetic polyneuropathy using neurological examination scores: correlation with nerve conduction studies. Egyptian Rheumatology and Rehabilitation. 2015 Jul;42(3):128–36.
Rohmatulloh VR, Riskiyah R, Pardjianto B, Sekar Kinasih L. Hubungan Usia dan Jenis Kelamin Terhadap Angka Kejadian Diabetes Mellitus Tipe 2 Berdasarkan 4 Kriteria Diagnosis di Poliklinik Penyakit Dalam RSUD Karsa Husada Kota Batu. PREPOTIF: Jurnal Kesehatan Masyarakat. 2024;8(1):2528–43.
Widianti W, Malvi AF, Zein Z, Kusnandang A. Faktor yang Memengaruhi Neuropati Diabetik Pada Pasien Diabetes Melitus Tipe 2 di RSUD Waled. Medika Kartika Jurnal Kedokteran dan Kesehatan [Internet]. 2024 Aug 30;(Volume 7 No 3):285–94. Available from: [http://medikakartika.unjani.ac.id/medikakartika/index.php/mk/article/view/1029](http://medikakartika.unjani.ac.id/medikakartika/index.php/mk/article/view/1029)
Sri Rahmi A, Syafrita Y, Susanti R. Hubungan Lama Menderita DM Tipe 2 Dengan Kejadian Neuropati Diabetik. Jambi Medical Journal. 2022;10(1):20–5.
Prashant P, Pal S, Bansal A, Fotedar S. Nerve conduction velocity studies in diabetic peripheral neuropathy involving sural nerve—A meta-analysis. J Family Med Prim Care [Internet]. 2024 Oct;13(10):4469–75. Available from: [https://journals.lww.com/10.4103/jfmpc.jfmpc_304_24](https://journals.lww.com/10.4103/jfmpc.jfmpc_304_24)
Haque F, Reaz MBI, Ali SHM, Arsad N, Chowdhury MEH. Performance analysis of noninvasive electrophysiological methods for the assessment of diabetic sensorimotor polyneuropathy in clinical research: a systematic review and meta-analysis with trial sequential analysis. Sci Rep. 2020 Dec 1;10(1).
Sepat P, Wasnik S. Sensory nerve conduction study of median ulnar and radial nerves in type 2 diabetic individuals in the age group 40–80 years. Heliyon. 2020 Oct 1;6(10).
Lakra B, Mohapatra S, Satapathy U. Study on electrophysiological changes of peripheral nerves in type 2 diabetes mellitus. Natl J Physiol Pharm Pharmacol. 2021;(0):1.
Hamid WS, Ahmed HS, Osman MA, Babiker R. Nerve conduction and its correlations with duration of diabetes mellitus and glycosylated haemoglobin in type 2 diabetes mellitus (T2DM). Journal of Endocrinology, Metabolism and Diabetes of South Africa. 2021 May 4;26(2):46–51.
Kobayashi M, Zochodne DW. Diabetic neuropathy and the sensory neuron: New aspects of pathogenesis and their treatment implications. Vol. 9, Journal of Diabetes Investigation. Blackwell Publishing; 2018. p. 1239–54.
Zamroni Z, Asmedi A, Nuradyo D. Neuropathy Symptom Score dan Neuropathy Deficit Score Sebagai Skor Diagnostik Neuropati Diabetik. Berkala Neurosains. 2016;15(1):46–53.
Destriyanah D, Christin T, Bahar E. Hubungan Kadar Magesium Serum dan Toronto Clinical Neuropathy Score Serta Parameter Hantar Saraf Pada Pasien Neuropati Diabetik di RSUP Dr Mohamad Hoesin Palembang. [Palembang]: Universitas Sriwijaya; 2021.
Nugraha MF, Sugiharto H, Haddani H, Bahar E. Efektivitas Injeksi Dekstrosa 5% Subkutan Pada Nyeri Neuropati Diabetik di RSUP Dr Mohammad Hoesin Palembang. [Palembang]: Universitas Sriwijaya; 2021.
Horinouchi S, Deguchi T, Mukai M, Ijuin A, Kawamoto Y, Nishio Y. Assessment of the severity of diabetic polyneuropathy aids in predicting the risk of developing diabetic complications in patients with untreated diabetes. Front Endocrinol (Lausanne). 2024;15.
