Vibrating device aids diabetic neuropathy foot screening

By Lynda Williams

A small disposable vibrating device may help detect peripheral sensory neuropathy in patients with diabetes, say UK researchers who believe the gadget could replace tuning fork screening.

The VibraTip, produced by the University Hospitals Bristol NHS Foundation Trust in the UK, provides a constant vibration that does not decay, and has good intra-rater reliability, report Fran Game (University of Nottingham) and co-workers.

The team applied the device to the feet of 141 patients, aged an average of 56.9 years, with Type 1 or 2 diabetes. The majority of patients had no history of ulceration but 40% had neuropathy. The device was held for 1 second at five sites: the first, second, and fifth metatarsal heads of the plantar surface, the hallux pulp, and the dorsal surface of the hallux proximal to the nail fold.

The VibraTip's ability to detect peripheral sensory neuropathy was compared with the gold standard of failure to detect a neurothesiometer stimulus of 25 V or higher in either foot at the hallux pulp. The VibraTip was also compared with a 10 g monofilament, designed to detect fine touch, a 128 Hz tuning fork at the hallux and medial malleolus, and a semi-blunt disposable pin.

Area under the receiver operating characteristic curve analysis indicated that two or more insensate sites from 10 sites tested using VibraTip, 10 g monofilament, and the pin. There was no significant difference between the VibraTip and the 10 g monofilament, and both tests were significantly better at detecting neuropathy than the tuning fork or the pin.

When tested by one clinician in 18 patients at a 2-3-week interval, the VibraTip had an alpha coefficient of 0.882, indicating good reliability, Game et al note in Diabetic Medicine.

The team concludes: "The VibraTip is a device comparable with the 10-g monofilament and therefore could be considered a useful tool for screening for peripheral sensory neuropathy in diabetes."

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