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Diagnostic performance of graded tuning fork vibration thresholds as a stand-alone test and within clinical assessments of diabetic neuropathy

Bonhof GJ, Ziegler D, Sipola G, Wagner R, Roden M, Strom A

Diabetes Research & Clinical Practice 2025 Jun;224(Epub 2025 may 8):112224

primary study

AIMS: We aimed to provide new reference data for C64 Hz-Rydel-Seiffer tuning fork Vibration Sensation Thresholds (VST) for the clinical diagnosis of Diabetic Sensorimotor Polyneuropathy (DSPN) and to evaluate the diagnostic performance when used in combination with other clinical tests as implemented in the Neuropathy Disability Score (NDS). METHODS: The study included 1,215 individuals with type 1 or type 2 diabetes and 207 with Normal Glucose Tolerance (NGT), who underwent clinical, electrophysiological, and Quantitative Sensory Tests (QST). Multiple regression analyses were used to determine VST in individuals with NGT. The diagnostic performance of tests to detect confirmed small or large fibre DSPN according to Toronto consensus criteria was assessed in 373 individuals with diabetes who underwent skin biopsies do determine intraepidermal nerve fibre density (IENFD).RESULTS: The new age-dependent lower normative VST showed 73.5% sensitivity, 85.4% specificity, and 82.3% accuracy in diagnosing confirmed DSPN. Combining VST with the PinPrick test resulted in 83.4% sensitivity, 80.3% specificity, and 81.2% accuracy. The NDS incorporating VST was associated with nerve conduction indices, QST, and IENFD. CONCLUSIONS: The new VST reference data shall enable clinicians to detect DSPN with higher accuracy in clinical practice, particularly when combined with a single small fibre test.
With permission from Excerpta Medica Inc.

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