Early identification of peripheral neuropathy based on sudomotor dysfunction in Mexican patients with type 2 diabetes

Angelica Carbajal-Ramírez,Adolfo Chávez-Negrete,Julián A Hernández-Domínguez,María Magdalena Rojas-Uribe,Mario A Molina-Ayala

doi:10.1186/s12883-019-1332-4

Angelica Carbajal-Ramírez, Adolfo Chávez-Negrete + Show 3 more

Open Access

https://doi.org/10.1186/s12883-019-1332-4

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Journal: BMC Neurology	Publication Date: May 31, 2019
Citations: 25	License type: open-access

Affiliation: Mexican Social Security Institute

Abstract

BackgroundType 2 Diabetes in Mexico has a high prevalence, 16–87% of patients may experience peripheral neuropathy. Early detection can prevent or halt its progression. The performance of Sudoscan in detecting neuropathy was compared to the Michigan Neuropathy Screening Instrument (MNSI). The aim was to identificate small fibers neuropathy.MethodsPatients type 2 diabetes received both MNSI and sudomotor function assessment through measurement of electrochemical skin conductance (ESC) in the hands and feet.ResultsTwo hundred twenty-one patients with neuropathy according to MNSI B had lower hands and feet ESC, regardless of diabetes duration. Among the 170 patients who had had diabetes for at least 5 years, 76 of them with normal MNSI B had abnormal hands or feet ESC; this was also the case in 28 out of 51 patients with diabetes than 5 or more years. In contrast, only 5 patients in the first group and 1 in the second group had abnormal MNSI B with normal ESC. Using MNSI B as a reference, abnormal hands or feet ESC (< 60 μS and 70 μS respectively) had a sensitivity of 97%, positive predictive value of 87% to detect neuropathy in patients with longer diabetes duration. The group with shorter diabetes duration, the sensitivity of abnormal hands or feet ESC to detect neuropathy was 91% while the positive predictive value was 88%.ConclusionsThe Sudoscan device, which does not require any preparation, is noninvasive, easy and rapid to perform, can be useful in the early diagnosis peripheral neuropathy in type 2 diabetic.

Highlights

Type 2 Diabetes in Mexico has a high prevalence, 16–87% of patients may experience peripheral neuropathy
In the group patients were older, had lower BMI, and had more severe neuropathy according to Michigan Neuropathy Screening Instrument (MNSI) B – they had lower hands and feet electrochemical skin conductance (ESC) (Table 1)
Patients with neuropathy according to MNSI B had lower hands and feet conductances (Fig. 1a and b)

Summary

Introduction

Type 2 Diabetes in Mexico has a high prevalence, 16–87% of patients may experience peripheral neuropathy. The performance of Sudoscan in detecting neuropathy was compared to the Michigan Neuropathy Screening Instrument (MNSI). In Mexico the prevalence is between 7.34% (2006 estimates) and 9.2%. According the ENSANUT survey in 2012 [3], 1.4% of diabetic patients received an amputation, underscoring the. The prevalence of diabetic peripheral neuropathy (DPN) varies according to different authors and instruments used for diagnosis; it is estimated to be between 16 and 87%. At time of diagnosis of type 2 diabetes, 7.5% of patients already have neuropathy [5,6,7] DPN has an annual incidence of 2% and is the most common neuropathy in industrialized countries [8]. In Mexico, 20% require foot amputation and 30% require a second amputation in the 12 months [9]

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Conclusion