Abstract
ObjectiveEvaluation of diabetic sensorimotor polyneuropathy (DSP) is hindered by the need for complex nerve conduction study (NCS) protocols and lack of predictive biomarkers. We aimed to determine the performance of single and simple combinations of NCS parameters for identification and future prediction of DSP.Materials and Methods406 participants (61 with type 1 diabetes and 345 with type 2 diabetes) with a broad spectrum of neuropathy, from none to severe, underwent NCS to determine presence or absence of DSP for cross-sectional (concurrent validity) analysis. The 109 participants without baseline DSP were re-evaluated for its future onset (predictive validity). Performance of NCS parameters was compared by area under the receiver operating characteristic curve (AROC).ResultsAt baseline there were 246 (60%) Prevalent Cases. After 3.9 years mean follow-up, 25 (23%) of the 109 Prevalent Controls that were followed became Incident DSP Cases. Threshold values for peroneal conduction velocity and sural amplitude potential best identified Prevalent Cases (AROC 0.90 and 0.83, sensitivity 80 and 83%, specificity 89 and 72%, respectively). Baseline tibial F-wave latency, peroneal conduction velocity and the sum of three lower limb nerve conduction velocities (sural, peroneal, and tibial) best predicted 4-year incidence (AROC 0.79, 0.79, and 0.85; sensitivity 79, 70, and 81%; specificity 63, 74 and 77%, respectively).DiscussionIndividual NCS parameters or their simple combinations are valid measures for identification and future prediction of DSP. Further research into the predictive roles of tibial F-wave latencies, peroneal conduction velocity, and sum of conduction velocities as markers of incipient nerve injury is needed to risk-stratify individuals for clinical and research protocols.
Highlights
Diabetic sensorimotor polyneuropathy (DSP) is the most common form of nerve injury in diabetes, with an estimated prevalence of 50% [1,2]
Foot ulcer and retinopathy were more common in Prevalent Cases but there was no difference in nephropathy
Thresholds for tibial F-wave latency, peroneal conduction velocity and sum of conduction velocities were identified for 4-year prediction of DSP, with sensitivities approaching 80% and specificities in the range of 70%
Summary
Diabetic sensorimotor polyneuropathy (DSP) is the most common form of nerve injury in diabetes, with an estimated prevalence of 50% [1,2]. It may involve motor, sensory, and autonomic nerves and is characterized by a nerve impairment that is symmetrical and length-dependent [3]. Sensory, and autonomic nerves and is characterized by a nerve impairment that is symmetrical and length-dependent [3] These variable attributes of nerve injury and their manifestations challenge diagnostic strategies for DSP. Though abnormalities in NCS have been shown to predict foot ulceration, amputation, and mortality, they have not been evaluated for prediction of incipient DSP at a stage that precedes its complications [8,9,10]
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