An 'Importance' Map of Signs and Symptoms to Classify Diabetic Polyneuropathy: An Exploratory Data Analysis

Autor(es)

Sacco, Isabel C. N. ; Suda, Eneida Yuri ; Vigneron, Vincent ; Sartor, Cristina Dallemole

• Tipo de documento: Artigo Científico
• Fonte: PLoS One; v. 10, n. 6, p. 16-pg., 2015-06-15.

Resumo

Aims/Hypothesis Early diagnosis of diabetic polyneuropathy (DPN) is critical for a good prognosis. We aimed to identify different groups of patients, based on the various common clinical signs and symptoms of DPN, that represent a progressive worsening of the disease before the onset of plantar ulceration or amputation. We also sought to identify the most important DPN-related variables that can discriminate between groups, thus representing the most informative variables for early detection. Methods In 193 diabetic patients, we assessed 16 DPN-related signs, symptoms, and foot characteristics, based on the literature and the International Consensus on the Diabetic Foot. We used multiple correspondence analysis and the Kohonen algorithm to group the variables into micro and macro-classes and to identify clusters of patients that represent different DPN conditions. Results Four distinct groups were observed. One group showed no indication of DPN. The remaining groups were characterized by a progressive loss of the vibration perception, without a worsening of symptoms or tactile perception. The 2 intermediate groups presented different aspects of DPN: one showed mostly DPN symptoms and the other showed the incipient vibration impairment, callus and crack formation, and foot arch alteration. The fourth group showed more severe foot and DPN conditions, including ulceration and amputation, absence of vibration and tactile perception (irrespective of how many compromised foot areas), and worse foot deformities and callus and crack formation. Conclusion Vibration perception was more informative than tactile sensitivity in discriminating early DPN onset because its impairment was evident in more groups. Symptoms and callus and cracks did not discriminate the severity status and should be interpreted in association with other clinical variables. Reconsideration of the current screening techniques is needed to clinically determine the early onset of neuropathy using tactile perception. (AU)

• Processo FAPESP: 13/06123-7 - Padrões dinâmicos de recrutamento muscular por EMG de alta densidade durante o ciclo da marcha de diabéticos em diferentes níveis de severidade de neuropatia classificados por um modelo linguístico fuzzy
• Beneficiário: Eneida Yuri Suda
• Modalidade de apoio: Bolsas no Brasil - Doutorado
• Processo FAPESP: 11/19304-4 - Influência da intervenção cinesioterapêutica em tornozelo e pé na biomecânica da marcha de diabéticos neuropatas: um ensaio clínico randomizado
• Beneficiário: Cristina Dallemole Sartor
• Modalidade de apoio: Bolsas no Brasil - Doutorado Direto