title: Electrochemical skin conductance to detect sudomotor dysfunction, peripheral neuropathy and the risk of foot ulceration among Saudi patients with diabetes mellitus.
abstract: BACKGROUND
  Sudomotor dysfunction is manifested clinically as abnormal sweating leading to dryness of feet skin and increased risk of foot ulceration. The aim of this study was to test the performance of foot electrochemical skin conductance (ESC) to detect diabetic peripheral neuropathy and the risk of foot ulceration against traditional methods in Saudi patients with diabetes mellitus.
  
  
  METHODS
  This cross-sectional study was conducted on 296 Saudi patients with diabetes mellitus. Painful neuropathic symptoms were evaluated using the neuropathy symptom score (NSS). The risk of foot ulceration and diabetic peripheral neuropathy were determined using the neuropathy disability score (NDS). Vibration perception threshold (VPT) was assessed using neurothesiometer. Neurophysiological assessment of the right and left sural, peroneal and tibial nerves was performed in 222 participants. Diabetic peripheral neuropathy was defined according to the definition of the American Academy of Neurology. ESC was measured with Sudoscan.
  
  
  RESULTS
  Feet-ESC decreased as the scores of sensory and motor function tests increased. Feet-ESC decreased as the NSS, NDS and severity of diabetic peripheral neuropathy increased. Sensitivity of feet-ESC < 50μS to detect diabetic peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 90.1, 61 and 63.8 % respectively and specificity 77, 85 and 81.9 % respectively. Sensitivity of feet-ESC < 70μS to detect diabetic peripheral neuropathy assessed by VPT ≥ 25 V, NDS ≥ 3, NDS ≥ 6 was 100, 80.6 and 80.9 % respectively. Sensitivity and specificity of feet-ESC < 70μS to detect confirmed-diabetic peripheral neuropathy were 67.5 and 58.9 % respectively.
  
  
  CONCLUSIONS
  Sudoscan a simple and objective tool can be used to detect diabetic peripheral neuropathy and the risk of foot ulceration among patients with diabetes mellitus. Prospective studies to confirm our results are warranted.
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Eman
authors: E
authors: Sheshah
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Amal
authors: A
authors: Madanat
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Fahad
authors: F
authors: Al-Greesheh
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Dalal
authors: D
authors: Al-Qaisi
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Mohammad
authors: M
authors: Al-Harbi
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Reem
authors: R
authors: Aman
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Abdul Aziz
authors: AA
authors: Al-Ghamdi
authors: Diabetes Care Center, King Salman Hospital (MOH), Ayesha Bint Abi Baker St., PO Box: 15169, Riyadh, 11444 Kingdom of Saudi Arabia.
authors: Khaled
authors: K
authors: Al-Madani
keywords: Diabetic peripheral neuropathy; Neuropathy disability score; Sudomotor dysfunction; Sudoscan