Abstract
Diabetes mellitus (DM) is the leading cause of polyneuropathy in the Western world. Diabetic neuropathy (DNP) is the most common complication of diabetes and is of great clinical significance mainly due to the pain and the possibility of ulceration in the lower limbs. Early detection of neuropathy is essential in the medical management of this complication. Early unmyelinated C-fiber dysfunction is one of the typical findings of diabetic neuropathy and the first clinical manifestation of dysfunction indicating sudomotor eccrine gland impairment. In order to assess newly developed technology for the measurement of dermal electrochemical conductance (DEC), we analyzed the feasibility and effectiveness of DEC (quantitative expression of sudomotor reflex) as a screening test of DNP in primary health care centers. The study included 197 people (with type 2 diabetes, prediabetes and normal tolerance) who underwent all the protocol tests and electromyography (EMG). On comparing DEC with EMG as the gold standard, the area under the receiver operating characteristic (ROC) curve (AUC, area under the curve) was 0.58 in the whole sample, AUC = 0.65 in the diabetes population and AUC = 0.72 in prediabetes, being irrelevant in subjects without glucose disturbances (AUC = 0.47). Conclusions: In usual clinical practice, DEC is feasible, with moderate sensitivity but high specificity. It is also easy to use and interpret and requires little training, thereby making it a good screening test in populations with diabetes and prediabetes. It may also be useful in screening general populations at risk of neuropathy.
Highlights
The prevalence of diabetes mellitus (DM) is very high in Spain, being approximately 14% according to oral glucose tolerance test (OGTT) results [1]
A prospective and blinded comparison was made between dermal electrochemical conductance (DEC) (Sudoscan®, Impeto Medical, Paris, France) and EMG; with Monofilament testing (MFT) 5.07 (10 g) Semmes-Weinstein; with Rydel-Seiffer 128 Hz tuning fork; and the Neuropathy Disability Score (NDS) score, in a consecutive sample of individuals attended in the primary care setting in the Vallès Occidental and Baix Camp counties (Catalonia, Spain), and their reference hospitals
The three groups showed significant differences in variables usually associated with diabetes, including family history, body mass index (BMI) and waist circumference, mean systolic blood pressure and comorbidities
Summary
The prevalence of diabetes mellitus (DM) is very high in Spain, being approximately 14% according to oral glucose tolerance test (OGTT) results [1]. Among the late microvascular events which may develop in patients with DM, polyneuropathy (PN) is the most common and disabling, and is the leading cause of morbidity and mortality in these patients [2]. In Spain, the leading cause of neuropathy is DM, with its prevalence increasing with the presence of DM and other risk factors such as obesity [3]. PN is defined as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with DM, after ruling out other possible causes [4]. The Toronto Panel Consensus on PN defined this disorder as a symmetrical, length-dependent sensorimotor PN attributed to metabolic and microvessel alterations due to chronic exposure to hyperglycemia and other risk factors. Dysfunction of the sweat reflex in small distal fibers is one of the earliest changes detected in these patients [5]
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