Tesfaye et al listed criteria for the clinical diagnosis of diabetic neuropathy. The authors are from the European Diabetes Prospective Complications Study Group representing multiple hospitals across Europe.
Pattern of neuropathy: distal symmetric polyneuropathy
Criteria for the diagnosis of diabetic neuropathy:
(1) presence of diabetes mellitus (patients in the study were insulin dependent)
(2) presence of 2 or more of the following findings:
(2a) presence of >= 1 symptom (see below)
(2b) absence of >= 2 reflexes for the left and right ankle and knee tendons (out of 4 total)
(2c) vibration-perception threshold abnormal for the patient's age (testing right great toe and the right medial malleolus)
(2d) abnormal autonomic function (see below)
(3) exclusion of other causes
Symptoms:
(1) numbness or dead feeling in feet
(2) prickling sensation in the feet
(3) deep aching or burning pains in the legs
(4) unusual difficulty in climbing the stairs
(5) difficulty with bladder control
(6) nocturnal diarrhea
Abnormal autonomic function - one or both of the following:
(1) postural hypotension with a fall in the systolic blood pressure >= 20 mm Hg
(2) heart rate variability with an RR ratio in the ECG of less than 1.04 after standing up
RR ratio after standing up =
= MAX(RR interval between 28th and 32nd beat after standing up) / MIN(RR interval between the 13th and 17th beat)
