Background: Diabetic peripheral neuropathy (DPN) frequently remains undiagnosed until complications arise. Nerve conduction studies (NCS) and autonomic function testing (AFT) are gold-standard diagnostic tools but are resource intensive. This study assessed clinical neurological examination as a screening tool for DPN. Subjects and Methods: An observational cross-sectional diagnostic accuracy study was conducted on 72 patients with type 2 diabetes mellitus at AIIMS Bhopal. Clinical neurological examination included tests for ankle reflex (absent in 35/72), pinprick sensation, vibration perception (reduced in 25/72), joint position sense, and monofilament testing (abnormal in 12/72). Diagnostic accuracy was assessed against NCS and AFT using sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Results: Clinical examination detected abnormalities in 52/72 (72%) patients. Against NCS-confirmed DPN (68/72), sensitivity was 69.23%, specificity 20%, PPV 69.23%, and NPV 20%. Against AFT-confirmed autonomic neuropathy (52/72), sensitivity was 70.59%, specificity 0%, PPV 92.3%, and NPV 0%. Conclusions: Clinical examination, especially for ankle reflex and vibration perception, is a valuable screening tool in resource-limited settings. However, it lacks accuracy in ruling out neuropathy, and confirmatory testing with NCS/AFT remains essential.
Dube et al. (Mon,) studied this question.