title: SUDOSCAN: A Simple, Rapid, and Objective Method with Potential for Screening for Diabetic Peripheral Neuropathy.
abstract: Clinical methods of detecting diabetic peripheral neuropathy (DPN) are not objective and reproducible. We therefore evaluated if SUDOSCAN, a new method developed to provide a quick, non-invasive and quantitative assessment of sudomotor function can reliably screen for DPN. 70 subjects (45 with type 1 diabetes and 25 healthy volunteers [HV]) underwent detailed assessments including clinical, neurophysiological and 5 standard cardiovascular reflex tests (CARTs). Using the American Academy of Neurology criteria subjects were classified into DPN and No-DPN groups. Based on CARTs subjects were also divided into CAN, subclinical-CAN and no-CAN. Sudomotor function was assessed with measurement of hand and foot Electrochemical Skin Conductance (ESC) and calculation of the CAN risk score. Foot ESC (μS) was significantly lower in subjects with DPN [n = 24; 53.5(25.1)] compared to the No-DPN [77.0(7.9)] and HV [77.1(14.3)] groups (ANCOVA p<0.001). Sensitivity and specificity of foot ESC for classifying DPN were 87.5% and 76.2%, respectively. The area under the ROC curve (AUC) was 0.85. Subjects with CAN had significantly lower foot [55.0(28.2)] and hand [53.5(19.6)] ESC compared to No-CAN [foot ESC, 72.1(12.2); hand ESC 64.9(14.4)] and HV groups (ANCOVA p<0.001 and 0.001, respectively). ROC analysis of CAN risk score to correctly classify CAN revealed a sensitivity of 65.0% and specificity of 80.0%. AUC was 0.75. Both foot and hand ESC demonstrated strong correlation with individual parameters and composite scores of nerve conduction and CAN. SUDOSCAN, a non-invasive and quick test, could be used as an objective screening test for DPN in busy diabetic clinics, insuring adherence to current recommendation of annual assessments for all diabetic patients that remains unfulfilled.
authors.affiliation: Department of Human Metabolism, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selvarajah
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Tom
authors.initials: T
authors.lastname: Cash
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davies
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Adithya
authors.initials: A
authors.lastname: Sankar
authors.affiliation: Department of Neurophysiology, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Ganesh
authors.initials: G
authors.lastname: Rao
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Marni
authors.initials: M
authors.lastname: Grieg
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Shillo
authors.initials: S
authors.lastname: Pallai
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.affiliation: Academic Unit of Radiology, University of Sheffield, Sheffield, United Kingdom.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.affiliation: Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, United Kingdom.
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis* / Q000503:physiopathology; D005260:Female; D005712:Galvanic Skin Response; D006801:Humans; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction; D012372:ROC Curve; D013997:Time Factors