Background: Screening for diabetic peripheral neuropathy (DPN) is easily omitted in the busy clinical setting. SUDOSCAN is a non-invasive and convenient tool for evaluating small-fiber neuropathy, but its clinical effectiveness for screening of DPN is lacking. We investigated whether SUDOSCAN combined with a neuropathy questionnaire could be an effective tool for screening for DPN in people with type 2 diabetes.
Methods: We analysed the data for 197 people with type 2 diabetes without renal dysfunction or changes in their use of anti-hyperglycaemic medications during the past 3 months. The presence of DPN was evaluated using the Michigan Neuropathy Screening Instrument Physical Examination (MNSI-PE). Electrochemical skin conductance (ESC) of the feet was assessed using SUDOSCAN, and the MNSI Questionnaire (MNSI-Q) and 10-gram monofilament tests were conducted. We developed a scoring model including various combinations of clinical parameters and neuropathy examination results.
Results: The prevalence of DPN was 42.6%. Participants with DPN were older (59.9 ± 9.5 vs. 56.7 ± 8.8 years) and had a longer duration of diabetes than those without DPN. Feet ESC distinguished the presence of DPN, and the optimal cut-off value was 69.5 uS. The OR for the association between an abnormal feet ESC (<70 uS) and the presence of DPN was 3.23 (95% CI 1.67, 6.42, p = 0.001). We made the DPN screening scores using the corresponding ORs for age, diabetes duration, and neuropathy evaluation. The MNSI-Q plus SUDOSCAN model (AUC 0.689), but not the MNSI-Q plus 10-gram monofilament model (AUC 0.668) showed better discrimination power than the MNSI-Q-only model (AUC 0.639).
Conclusions: The screening model for DPN that includes SUDOSCAN and the MNSI-Q can detect DPN with acceptable discrimination power and is more convenient than neurophysiological studies. This strategy may be useful in the busy outpatient clinical setting.
T. Oh: None. K. Kim: None. Y. Shin: None. H. Jang: Speaker’s Bureau; Self; Daiichi Sankyo, Handok, Pfizer Inc., Takeda Pharmaceutical Company Limited. S. Choi: None.
Korean Diabetes Association (2016F-5)