An assessment of the patterns and severity of diabetic neuropathy using the modified - Toronto Clinical Neuropathy Score in recently detected diabetics

Aaron Charles Lobo, Peter George, Kavina Marian Fernandes


Introduction: Diabetic neuropathy is among the commonest vascular complication of diabetes mellitus. Even individuals with pre-diabetes are at risk of developing diabetic neuropathy (DN). Over 50% of individuals with DN are asymptomatic, keeping them at a higher risk of developing diabetic foot. The study aimed to ascertain the patterns and severity of diabetic neuropathy among patients with recently detected diabetes mellitus, using the modified -Toronto Clinical Neuropathy Score (m-TCNS).

Materials & methods: This prospective observational study was done on 50 patients with diabetes of less than 1 year duration. Patients who fulfilled the selection criteria were recruited to the study after obtaining a written informed consent. After obtaining details of their medical history, clinical examination and investigations, patients underwent m-TCNS. Laboratory tests included sugar levels, HbA1c and urine albumin. The incidence, severity and patterns of diabetic neuropathy (DN) and its correlation to the duration, diabetes control, presence of retinopathy and albuminuria were analyzed by descriptive statistics, Chi-square test and t test.

Results: Among the 50 patients, there were 18 males and 32 females with a mean (SD) age of 56.44 (+10. 82) years. Among them, 29 patients were new to treatment for diabetes. The average random blood sugar (RBS) and glycated hemoglobin (HbA1c) were 249.92 (126.63) mg/dl and 10.532 (10.64) gm% respectively. Only 46% patients had symptoms and 34% had signs of diabetic neuropathy. Pain being the commonest symptom (24%) and loss of vibration sense the most frequent sign (26%) in these patients. Features of diabetic retinopathy and albuminuria were present in 6/50 (12%) and 20/50 (40%) patients respectively. The presence or severity of neuropathic signs or symptoms had no statistically significant correlation to their glycemic control. There was a significant correlation of presence of neuropathy with albuminuria and retinopathy.

Conclusion: The study establishes the use of m-TCNS as a simple and good screening tool to detect diabetic neuropathy. Pain and loss of vibration sense were the most common symptom and sign in DN. The severity of neuropathy was mild in this study, but had a significant correlation with other microvascular complications. We recommend all newly detected patients with diabetes to undergo screening tests for its microvascular complications.


Diabetic Neuropathy, clinical screening, modified Toronto Clinical Neuropathy Score, m-TCNS, recently detected Diabetes

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