11-OR: Combined DPNCheck and SUDOSCAN as a Screening Tool for DPN—The Sheffield Prospective Study

Introduction & Objective: Diabetic peripheral neuropathy (DPN) is often diagnosed late. Point-of-care-devices (POCDs, ‘DPN-Check’ a handheld device which measures sural-nerve conduction-velocity/amplitude and SUDOSCAN a test of sudomotor-function) are objective, quick tests that when combined; accurately diagnose DPN. However, the ability of POCDs to predict incident DPN is unknown, and was examined in this prospective study.

Methods: 229 consecutive participants with diabetes who attended one-stop microvascular screening service were re-called for follow-up evaluation at 7 years. Baseline assessments were repeated including: clinical and neurophysiological assessments of DPN [Toronto Clinical Neuropathy Score (TCNS),10g monofilament (10g-MFT), POCDs and nerve conduction studies (NCS). Risk of developing incident DPN was assessed using the odds-ratio for the diagnosis of DPN using clinical (TCNS, 10gMFT) and NCS.

Results: 90 participants have completed follow up visits. Patients attending follow up were significantly younger [57.8(11.9)vs62.5(14.2)years; (p<0.001(95%CI 4.1:11.4)] than those who did not (n=139), and had lower number of co-morbidities [3.0vs5.5; P<0.001] and Q-risk (20.3(13.1)vs29.3(13.5); p<0.001). Thirty-four (37.8%) patients had incident 10g MFT abnormality at follow-up. Patients with abnormal POCDs had a OR 7.1(p<0.001;95%CI:2.3:22.8) times greater risk of 10g-MFT abnormality compared to those with normal POCDs at baseline. Similar increased risk of incident DPN were found when DPN was diagnosed using TCNS [OR 4.0(95%CI1.0:15.2, p=0.03)] and NCS [OR 11.9(95%CI:1.5:96.0, p=0.005)].

Conclusions: We have demonstrated significantly increased risk of incident clinical DPN in patients with abnormal baseline POCDs (microalbuminuria equivalent). These findings support the use of POCDs as a screening tool for early DPN diagnosis, when cardio-metabolic control may halt the progressive neuropathic process.