title: Assessment of diabetic neuropathy using a point-of-care nerve conduction device shows significant associations with the LDIFLARE method and clinical neuropathy scoring.
abstract: Accurate assessment of diabetes polyneuropathy (DPN) is important in the prevention of foot ulcerations and amputations. Simple screening methods including the 10 g monofilament and the 128-Hz tuning fork are not sensitive enough nor intended for detection of early neuropathy, while more confirmatory tests such as nerve conduction studies are not universally available. We evaluated a rapid, low-cost, point-of-care nerve conduction device (POCD; NC-stat®|DPNCheck™) for the assessment of DPN and compared it with the LDIFLARE technique-an established method for early detection of small fibre dysfunction. A total of 162 patients with diabetes (DM) and 80 healthy controls (HC) were recruited. Based on the 10-point Neuropathy Disability Score (NDS), DPN was categorized into none (<2), mild (3-5) moderate (6-7), and severe (8-10). The LDIFLARE was performed in all patients according to previously described methodology. The associations between POCD outcomes and the LDIFLARE within the NDS categories were evaluated using regression analysis. In HC and DM, SNCV measured with the POCD correlated significantly with the LDIFLARE technique (r < 0.90 and r = 0.78, respectively) as did SNAP (r = 0.88 and r = 0.73, respectively); in addition, significance was found in all categories of DPN (r = 0.64 to 0.84; p= ≤ 0.03). ROC curves within each category of DPN showed that the POCD was sensitive in the assessment of DPN. We report highly significant linear relationships between the POCD with both comparators-the LDIFLARE technique and clinical neuropathy scores. Thus, the NC-stat|DPNCheck™ system appears to be an excellent adjunctive diagnostic tool for diagnosing DPN in the clinical setting.
authors.affiliation: Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, UK.
authors.forename: Prashanth Rj
authors.initials: PR
authors.lastname: Vas
authors.affiliation: Diabetes Research Unit, The Ipswich Hospital NHS Trust, Ipswich, UK gerry.rayman@ipswichhospital.nhs.uk.
authors.forename: Gerry
authors.initials: G
authors.lastname: Rayman
mesh_terms: D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D005260:Female; D006801:Humans; D017078:Laser-Doppler Flowmetry; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D009460:Neurologic Examination / Q000295:instrumentation*; D000067716:Point-of-Care Testing; D011379:Prognosis; D018608:Ultrasonography, Doppler / Q000379:methods; D055815:Young Adult
keywords: diabetes neuropathy; early detection; laser doppler imaging; point-of-care device; sural nerve conduction studies