The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy. Issue 12 (14th July 2014)

• Record Type: Journal Article
• Authors: Ponirakis, G.; Petropoulos, I. N.; Fadavi, H.; Alam, U.; Asghar, O.; Marshall, A.; Tavakoli, M.; Malik, R. A.
• Is Part Of: Diabetic medicine. Volume 31:Issue 12(2014:Dec.)
• Page Start: 1673
• Page End: 1680
• Publication Date: 2014-07-14
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.12536
• Languages: English
• ISSNs: 0742-3071

Abstract

<abstract abstract-type="main" id="dme12536-abs-0001"> <title>Abstract</title> <sec id="dme12536-sec-0001" sec-type="section"> <title>Aims</title> <p>Neuropad<sup><bold>®</bold></sup> is a simple visual indicator test, with moderate diagnostic performance for diabetic peripheral neuropathy. As it assesses sweating, which is a measure of cholinergic small nerve fibre function, we compared its diagnostic performance against established measures of both large and, more specifically, small fibre damage in patients with diabetes.</p> </sec> <sec id="dme12536-sec-0002" sec-type="section"> <title>Methods</title> <p>One hundred and twenty‐seven participants (89 without diabetic peripheral neuropathy and 38 with) aged 57 ± 9.7 years underwent assessment with Neuropad, large nerve fibre assessments: Neuropathy Disability Score, vibration perception threshold, peroneal motor nerve conduction velocity; small nerve fibre assessments: neuropathy symptoms (Diabetic Neuropathy Symptoms score) corneal nerve fibre length and warm perception threshold.</p> </sec> <sec id="dme12536-sec-0003" sec-type="section"> <title>Results</title> <p>Neuropad has a high sensitivity but moderate specificity against large fibre neuropathy assessments: Neuropathy Disability Score (> 2) 70% and 50%, vibration perception threshold (> 14 V) 83% and 53%, and peroneal motor nerve conduction velocity (< 42 m/s) 81% and 54%, respectively. However, the diagnostic accuracy of Neuropad was significantly improved against corneal nerve fibre length (< 14 mm/mm<sup>2</sup>) with a sensitivity and specificity of 83% and 80%, respectively. Furthermore, the area under the curve for corneal nerve fibre length (85%) was significantly greater than with the Neuropathy Disability Score (66%, <italic>P</italic> = 0.01) and peroneal motor nerve conduction velocity (70%, <italic>P</italic> = 0.03). For neuropathic symptoms, sensitivity was 78% and specificity was 60%.</p> </sec> <sec id="dme12536-sec-0004" sec-type="section"> <title>Conclusions</title> <p>The data show the improved diagnostic performance of Neuropad against corneal nerve fibre length. This study underlines the importance of Neuropad as a practical diagnostic test for small fibre neuropathy in patients with diabetes.</p> </sec> </abstract>