Efficacy of proprioception test in the early detection of diabetic peripheral neuropathy

Background
Diabetic peripheral neuropathy (DPN) is the most common microvascular complication of diabetes. It is characterized by progressive nerve damage, predominantly affecting sensory, motor, and autonomic nerves, leading to symptoms such as numbness, tingling, and pain. Early identification is critical to prevent serious complications, including foot ulcers, infections, and amputations, thus reducing morbidity and healthcare burden. Assessing proprioception could serve as a potential tool for early detection of neuropathy due to its sensitivity to subtle changes in nerve function.

Aims
This study aimed to investigate whether the proprioception test could effectively detect early-stage DPN in type 2 diabetes mellitus (T2DM) patients.

Material and methods
A group of 114 T2DM patients of less than five years duration, between the age group 30-60 years, participated in the study. The control group consisted of 114 age and gender-matched healthy individuals. Nerve conduction study (NCS) of Tibial motor, Peroneal motor and Sural sensory nerves was done. Proprioception was assessed by testing the absolute error scores of the knee Joint Position Sense (JPS) with a Digital inclinometer. Data were analyzed with SPSS software, version 26 (IBM, USA).

Results
There was a significant difference between the two groups, both in NCS parameters and JPS errors. A significant correlation between the JPS errors and NCS variables was also observed. The optimum cut-point for the JPS test was determined as ≥ 4.6 degrees with optimum sensitivity and specificity of 77% and 53% respectively. The Area under the curve (AUC) with a 95% confidence interval was 0.7568 (0.6923 – 0.82). The accuracy of the test was 62% with a Likelihood ratio positive of +1.47.

Conclusions
The proprioception test demonstrates moderate efficacy as an early screening tool for diabetic peripheral neuropathy (DPN), with sufficient sensitivity to identify subtle neuropathic changes in T2DM patients. Implementing this simple, cost-effective assessment could aid in the timely diagnosis and management of DPN, potentially reducing associated morbidity