Strong association between vibration perception thresholds at low frequencies (4 and 8 Hz), neuropathic symptoms and diabetic foot ulcers
To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms. VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5...
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| Published in | PloS one Vol. 14; no. 2; p. e0212921 |
|---|---|
| Main Authors | , , , , |
| Format | Journal Article |
| Language | English |
| Published |
United States
Public Library of Science
28.02.2019
Public Library of Science (PLoS) |
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| Online Access | Get full text |
| ISSN | 1932-6203 1932-6203 |
| DOI | 10.1371/journal.pone.0212921 |
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| Abstract | To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.
VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).
The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.
Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. |
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| AbstractList | To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.
VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).
The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.
Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.AIMSTo investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).METHODSVPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.RESULTSThe VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers.CONCLUSIONSVibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms. VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz). The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration ([less than or equal to] 10 yrs.) T1DM patients compared to age- and gender-matched control subjects. Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. Aims To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms. Methods VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz). Results The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration ([less than or equal to] 10 yrs.) T1DM patients compared to age- and gender-matched control subjects. Conclusions Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. Aims To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms. Methods VPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz). Results The VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (? 10 yrs.) T1DM patients compared to age- and gender-matched control subjects. Conclusions Vibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. AimsTo investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic foot ulcer or neuropathic symptoms.MethodsVPTs were measured at six different frequencies (4, 8, 16, 32, 64 and 125 Hz) on metatarsal heads 1 and 5 on the sole of the foot using a standard VibroSense Meter device in 535 type 1 diabetic (T1DM) patients and 717 non-diabetic control subjects. VPTs in control subjects were used to establish normal values for five different age groups for male and female subjects respectively. Normal values were defined as a VPT below the mean plus 1.66 x standard deviation for each group. Various definitions of abnormal VPTs were tested using either all frequencies, only lowest VPT frequencies (4 and 8 Hz) or only highest VPT frequencies (64 and 125 Hz).ResultsThe VPTs were higher in T1DM patients than in non-diabetic control subjects matched for age and gender. The low frequencies, 4 and 8 Hz, particularly were associated with the risk of diabetic foot ulcer (OR 40.7 [5.4-308.4], p = 0.0003) and with difficulties in balance and or gait (OR 1.89 [1.04-3.46], p = 0.04) difficulties and weakness (OR 2.77 [1.25-6.16], p = 0.01). The VPTs at the 125 Hz frequency were higher in short duration (≤ 10 yrs.) T1DM patients compared to age- and gender-matched control subjects.ConclusionsVibration perception thresholds at low frequencies seem to be a better indicator of the risk of developing diabetic foot ulcers, gait or balance problems or weakness of the foot. The 125 Hz frequency, however, seemed to be impaired earlier and it was the only pathological VPT frequency in patients with short duration of diabetes.This study suggests that at least four different frequencies (4, 8, 64 and 125 Hz) should be included in any examination in order to obtain a complete evaluation of the risk factors for diabetic neuropathy and diabetic foot ulcers. |
| Audience | Academic |
| Author | Fagher, Katarina Dahlin, Lars B. Löndahl, Magnus Apelqvist, Jan Lindholm, Eero |
| AuthorAffiliation | 3 Department of Translational Medicine—Hand Surgery, Lund University, Malmö, Sweden 4 Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden Baylor College of Medicine, UNITED STATES 2 Department of Clinical Sciences, Endocrinology, Lund University, Lund, Sweden 1 Department of Clinical Sciences, Endocrinology, Lund University, Malmö, Sweden |
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| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/30817797$$D View this record in MEDLINE/PubMed |
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| References_xml | – volume: 118 start-page: 1931 issue: 4 year: 2017 ident: ref18 article-title: The firing characteristics of foot sole cutaneous mechanoreceptor afferents in response to vibration stimuli publication-title: J Neurophysiol doi: 10.1152/jn.00647.2016 – volume: 38 start-page: 539 issue: 3 year: 1975 ident: ref9 article-title: Capacities of humans and monkeys to discriminate vibratory stimuli of different frequency and amplitude: a correlation between neural events and psychological measurements publication-title: J Neurophysiol doi: 10.1152/jn.1975.38.3.539 – volume: 2017 start-page: 1467213 year: 2017 ident: ref6 article-title: A Comparison of Screening Tools for the Early Detection of Peripheral Neuropathy in Adults with and without Type 2 Diabetes publication-title: J Diabetes Res doi: 10.1155/2017/1467213 – volume: 6 start-page: 33 year: 2014 ident: ref22 article-title: Cutaneous stimulation of discrete regions of the sole during locomotion produces "sensory steering" of the foot publication-title: BMC Sports Sci Med Rehabil doi: 10.1186/2052-1847-6-33 – volume: 17 start-page: 557 issue: 6 year: 1994 ident: ref10 article-title: The prediction of diabetic neuropathic foot ulceration using vibration perception thresholds. A prospective study publication-title: Diabetes Care doi: 10.2337/diacare.17.6.557 – volume: 42 start-page: 79 issue: 1 year: 1994 ident: ref7 article-title: The structure and function of Pacinian corpuscles: a review publication-title: Prog Neurobiol doi: 10.1016/0301-0082(94)90022-1 – volume: 376 start-page: 2367 issue: 24 year: 2017 ident: ref1 article-title: Diabetic Foot Ulcers and Their Recurrence publication-title: N Engl J Med doi: 10.1056/NEJMra1615439 – volume: 8 start-page: 157 issue: 2 year: 1991 ident: ref15 article-title: Vibration perception threshold: influence of age, height, sex, and smoking, and calculation of accurate centile values publication-title: Diabet Med doi: 10.1111/j.1464-5491.1991.tb01563.x – volume: 20 start-page: 756 issue: 11 year: 1971 ident: ref19 article-title: Diabetes in the Pima Indians. Evidence of bimodality in glucose tolerance distributions publication-title: Diabetes doi: 10.2337/diab.20.11.756 – volume: 40 start-page: 136 issue: 1 year: 2017 ident: ref4 article-title: Diabetic Neuropathy: A Position Statement by the American Diabetes Association publication-title: Diabetes Care doi: 10.2337/dc16-2042 – volume: 35 start-page: 122 issue: 1 year: 1972 ident: ref8 article-title: Detection thresholds for stimuli in humans and monkeys: comparison with threshold events in mechanoreceptive afferent nerve fibers innervating the monkey hand publication-title: J Neurophysiol doi: 10.1152/jn.1972.35.1.122 – volume: 28 start-page: 1451 issue: 6 year: 2005 ident: ref20 article-title: Bimodality of 2-h plasma glucose distributions in whites: the Rancho Bernardo study publication-title: Diabetes Care doi: 10.2337/diacare.28.6.1451 – volume: 13 start-page: e0196243 issue: 4 year: 2018 ident: ref14 article-title: Impaired vibrotactile sense in children and adolescents with type 1 diabetes—Signs of peripheral neuropathy publication-title: PLoS One doi: 10.1371/journal.pone.0196243 – volume: 8 start-page: 77 issue: 1 year: 2014 ident: ref5 article-title: Evaluation of clinical tools and their diagnostic use in distal symmetric polyneuropathy publication-title: Prim Care Diabetes doi: 10.1016/j.pcd.2013.04.004 – volume: 26 start-page: 275 issue: 3 year: 1992 ident: ref16 article-title: Vibrotactile function of the hand in compression and vibration-induced neuropathy. Sensibility index—a new measure publication-title: Scand J Plast Reconstr Surg Hand Surg doi: 10.3109/02844319209015271 – volume: 25 start-page: 309 issue: 2 year: 2017 ident: ref2 article-title: Recurrent and other new foot ulcers after healed plantar forefoot diabetic ulcer publication-title: Wound Repair Regen doi: 10.1111/wrr.12522 – volume: 18 start-page: 469 issue: 6 year: 2001 ident: ref23 article-title: Vibration perception threshold testing in patients with diabetic neuropathy: ceiling effects and reliability publication-title: Diabet Med doi: 10.1046/j.1464-5491.2001.00503.x – volume: 29 start-page: e449 issue: 12 year: 2012 ident: ref12 article-title: Vibration thresholds are increased at low frequencies in the sole of the foot in diabetes-a novel multi-frequency approach publication-title: Diabet Med doi: 10.1111/dme.12024 – volume: 28 start-page: 1045 issue: 9 year: 2011 ident: ref13 article-title: Disturbed vibrotactile sense in finger pulps in patients with Type 1 diabetes—correlations with glycaemic level, clinical examination and electrophysiology publication-title: Diabet Med doi: 10.1111/j.1464-5491.2011.03328.x – volume: 24 start-page: 240 issue: 3 year: 2011 ident: ref24 article-title: Progress in vibrotactile threshold evaluation techniques: a review publication-title: J Hand Ther doi: 10.1016/j.jht.2011.01.001 – volume: 120 start-page: 855 issue: 8 year: 2016 ident: ref21 article-title: Vibrotactile stimulation of fast-adapting cutaneous afferents from the foot modulates proprioception at the ankle joint publication-title: J Appl Physiol (1985) doi: 10.1152/japplphysiol.00810.2015 – volume: 127 start-page: 235 year: 2016 ident: ref3 article-title: Alternative Quantitative Tools in the Assessment of Diabetic Peripheral and Autonomic Neuropathy publication-title: Int Rev Neurobiol doi: 10.1016/bs.irn.2016.03.010 – volume: 9 start-page: 38 issue: 1 year: 2014 ident: ref11 article-title: Test-retest reliability of neurophysiological tests of hand-arm vibration syndrome in vibration exposed workers and unexposed referents publication-title: J Occup Med Toxicol doi: 10.1186/s12995-014-0038-1 – volume: 10 start-page: e0119753 issue: 3 year: 2015 ident: ref17 article-title: Vibrotactile perception in finger pulps and in the sole of the foot in healthy subjects among children or adolescents publication-title: PLoS One doi: 10.1371/journal.pone.0119753 |
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| Snippet | To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing diabetic... Aims To investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing... AimsTo investigate whether multi-frequency measurement of vibration perception thresholds (VPTs) can identify individuals with a high risk of developing... |
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| SubjectTerms | Adult Analysis Biology and Life Sciences Case-Control Studies Clinical Medicine Diabetes Mellitus, Type 1 - complications Diabetes Mellitus, Type 1 - physiopathology Diabetic foot Diabetic Foot - etiology Diabetic Foot - physiopathology Diabetic neuropathies Diabetic Neuropathies - etiology Diabetic Neuropathies - physiopathology Endocrinology and Diabetes Endokrinologi och diabetes Female Foot ulcer Humans Klinisk medicin Male Medical and Health Sciences Medical research Medicin och hälsovetenskap Medicine and Health Sciences Middle Aged Physical Sciences Research and Analysis Methods Risk Factors Sensory Thresholds - physiology Touch Perception - physiology Vibration Women Women's health |
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| Title | Strong association between vibration perception thresholds at low frequencies (4 and 8 Hz), neuropathic symptoms and diabetic foot ulcers |
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