Sensory changes in the upper limb in type 2 diabetic patients - A case control study

Context: Sensory changes are associated with diabetic neuropathy and the assessment of sensation is commonly done in the foot to prevent ulcers. Though sensory changes may be present in the upper limb also, its documentation is not done routinely. Aims: To find out the two point discrimination values and other sensory changes in the upper limb in type 2 diabetic patients. Settings and design: This was a cross sectional design using a case control study, which was done in a hospital with both inpatients and out patients. Methods and material: 75 subjects with type 2 diabetes were included in the case group; patients with a diagnosed case of neuropathy were excluded. These were compared with age and sex matched subjects in the control group with no diabetes. Vibration sensation, pressure threshold and two point discrimination were assessed on the hands in both the groups. The Duruoz's Hand Index was used to assess the general functional status with regards to the abilities of daily living in both the groups. Statistical analysis: The data was analysed by using the SPSS package, version 13, with p values <.05 being taken as significant. Results: In the diabetic group, approximately 11 % of the patients had the loss of protective sensation; the median value of the vibration sensation was 11-14 volts as compared to 3-4 volts in the control group and the mean value of the two point discrimination was 4-5mm. The results were significantly different between the diabetic and the control groups. The median value of DHI was eight in the diabetic group. Conclusions: All the sensations which were checked were altered in the diabetic patients, thus indicating the possible underlying neuropathy changes. The two point discrimination test can be used to detect upper limb neuropathy in patients with type 2 diabetes, which can further be validated with nerve conduction velocity tests. A sensory evaluation should be done in the upper limb, especially with patients who had diabetes for more than five years, for the possible presence of neuropathy.