title: Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic.
abstract: OBJECTIVE
  This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy.
  
  
  METHODS
  A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard.
  
  
  RESULTS
  According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy.
  
  
  CONCLUSIONS
  The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment.
authors.affiliation: Faculdade de Medicina da Universidade de São Paulo, Physical Therapy, Speech and Occupational Therapy Department, Brazil.
authors.forename: Andreja P
authors.initials: AP
authors.lastname: Picon
authors.forename: Neli R S
authors.initials: NR
authors.lastname: Ortega
authors.forename: Ricky
authors.initials: R
authors.lastname: Watari
authors.forename: Cristina
authors.initials: C
authors.lastname: Sartor
authors.forename: Isabel C N
authors.initials: IC
authors.lastname: Sacco
mesh_terms: D003929:Diabetic Neuropathies / Q000145:classification*; D005103:Expert Systems; D017143:Fuzzy Logic; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D012372:ROC Curve; D012720:Severity of Illness Index; D035501:Uncertainty