title: Automated Quantification of Neuropad Improves Its Diagnostic Ability in Patients with Diabetic Neuropathy.
abstract: Neuropad is currently a categorical visual screening test that identifies diabetic patients at risk of foot ulceration. The diagnostic performance of Neuropad was compared between the categorical and continuous (image-analysis (Sudometrics)) outputs to diagnose diabetic peripheral neuropathy (DPN). 110 subjects with type 1 and 2 diabetes underwent assessment with Neuropad, Neuropathy Disability Score (NDS), peroneal motor nerve conduction velocity (PMNCV), sural nerve action potential (SNAP), Deep Breathing-Heart Rate Variability (DB-HRV), intraepidermal nerve fibre density (IENFD), and corneal confocal microscopy (CCM). 46/110 patients had DPN according to the Toronto consensus. The continuous output displayed high sensitivity and specificity for DB-HRV (91%, 83%), CNFD (88%, 78%), and SNAP (88%, 83%), whereas the categorical output showed high sensitivity but low specificity. The optimal cut-off points were 90% for the detection of autonomic dysfunction (DB-HRV) and 80% for small fibre neuropathy (CNFD). The diagnostic efficacy of the continuous Neuropad output for abnormal DB-HRV (AUC: 91%, P = 0.0003) and CNFD (AUC: 82%, P = 0.01) was better than for PMNCV (AUC: 60%). The categorical output showed no significant difference in diagnostic efficacy for these same measures. An image analysis algorithm generating a continuous output (Sudometrics) improved the diagnostic ability of Neuropad, particularly in detecting autonomic and small fibre neuropathy.
authors.affiliation: Research Division, Weill Cornell Medical College in Qatar, Qatar Foundation, P.O. Box 24144, Education City, Doha, Qatar ; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Georgios
authors.initials: G
authors.lastname: Ponirakis
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Hassan
authors.initials: H
authors.lastname: Fadavi
authors.affiliation: Research Division, Weill Cornell Medical College in Qatar, Qatar Foundation, P.O. Box 24144, Education City, Doha, Qatar ; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Ioannis N
authors.initials: IN
authors.lastname: Petropoulos
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Shazli
authors.initials: S
authors.lastname: Azmi
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Maryam
authors.initials: M
authors.lastname: Ferdousi
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK ; Roke Manor Research Ltd, Old Salisbury Lane, Romsey, Hampshire SO51 0ZN, UK.
authors.forename: Mohammad A
authors.initials: MA
authors.lastname: Dabbah
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Kheyami
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Uazman
authors.initials: U
authors.lastname: Alam
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Omar
authors.initials: O
authors.lastname: Asghar
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Marshall
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Mitra
authors.initials: M
authors.lastname: Tavakoli
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Ahmar
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Saad
authors.initials: S
authors.lastname: Javed
authors.affiliation: Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Jeziorska
authors.affiliation: Research Division, Weill Cornell Medical College in Qatar, Qatar Foundation, P.O. Box 24144, Education City, Doha, Qatar ; Institute of Human Development, Centre for Endocrinology & Diabetes, Faculty of Medical and Human Sciences, University of Manchester and NIHR/Wellcome Trust Clinical Research Facility, Manchester M13 9NT, UK.
authors.forename: Rayaz A
authors.initials: RA
authors.lastname: Malik
mesh_terms: D000200:Action Potentials / Q000502:physiology; D001341:Autonomic Nervous System / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D016523:Foot Ulcer / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D009431:Neural Conduction / Q000502:physiology; D010808:Physical Examination; D012680:Sensitivity and Specificity; D013497:Sural Nerve / Q000503:physiopathology