Exp Clin Endocrinol Diabetes 2011; 119(2): 122-125
DOI: 10.1055/s-0030-1261934
Short Communication

© J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York

A Prospective Study on the use of the Indicator Test Neuropad® for the Early Diagnosis of Peripheral Neuropathy in type 2 Diabetes

N. Papanas1 , K. Papatheodorou1 , D. Papazoglou1 , S. Kotsiou1 , E. Maltezos1
  • 1Outpatient Clinic of Obesity, Diabetes and Metabolism in the Second Department of Internal Medicine, Democritus University of Thrace, Greece
Further Information

Publication History

received 23.05.2010 first decision 23.05.2010

accepted 23.06.2010

Publication Date:
05 August 2010 (online)

Abstract

Aim: The aim of this prospective study was to evaluate the contribution of the indicator test for sudomotor function Neuropad® to the early diagnosis of peripheral neuropathy in patients with type 2 diabetes mellitus. Included were 109 type 2 diabetic patients (55 men, mean age 56.15±6.14 years), whose initial clinical examination (Neuropathy Disability Score, NDS) was negative for neuropathy. Patients were first examined between January and June 2004 and re-examined 5 years later by the NDS and Neuropad®. Initially, 70 patients (64.22%) had normal and 39 (35.78%) patients had abnormal Neuropad® (groups A and B, respectively). NDS was significantly higher in group B on both examinations (p<0.001). On the second examination, 2 patients (2.86%) in group A and 10 patients (25.64%) in group B had developed neuropathy (p=0.001). Neuropad® had 83.33% sensitivity and 68.04% specificity for neuropathy. There was a modest but significant agreement (kappa=0.259, p<0.001) between Neuropad® and NDS for neuropathy.

Conclusions: Among type 2 diabetic patients with normal NDS, development of neuropathy is significantly more frequent in those with abnormal Neuropad®. These results suggest a potential utility of Neuropad® for the earlier diagnosis of neuropathy in type 2 diabetes.

References

  • 1 Boulton AJ, Vinik AI, Arezzo JC. et al . Diabetic neuropathies: a statement by the American Diabetes Association.  Diabetes Care. 2005;  28 956-962
  • 2 Herman WH, Kennedy L. Underdiagnosis of peripheral neuropathy in type 2 diabetes.  Diabetes Care. 2005;  28 1480-1481
  • 3 Kamenov ZA, Petrova JJ, Christov VG. Diagnosis of diabetic neuropathy using simple somatic and a new autonomic (neuropad) tests in the clinical practice.  Exp Clin Endocrinol Diabetes. 2010;  118 226-233
  • 4 Krarup C. An update on neurophysiological studies in neuropathy.  Curr Opin Neurol. 2003;  16 603-612
  • 5 Liatis S, Marinou K, Tentolouris N. et al . Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus.  Diabet Med. 2007;  24 1375-1380
  • 6 Low VA, Sandroni P, Fealey RD. et al . Detection of small-fiber neuropathy by sudomotor testing.  Muscle Nerve. 2006;  34 57-61
  • 7 Malik RA, Tesfaye S, Newrick PG. et al . Sural nerve pathology in diabetic patients with minimal but progressive neuropathy.  Diabetologia. 2005;  48 578-585
  • 8 Papanas N, Papatheodorou K, Christakidis D. et al . Evaluation of a new indicator test for sudomotor function (Neuropad) in the diagnosis of peripheral neuropathy in type 2 diabetic patients.  Exp Clin Endocrinol Diabetes. 2005;  113 195-198
  • 9 Papanas N, Papatheodorou K, Papazoglou D. et al . Reproducibility of the new indicator test for sudomotor function (Neuropad) in patients with type 2 diabetes mellitus: short communication.  Exp Clin Endocrinol Diabetes. 2005b;  113 577-581
  • 10 Papanas N, Papatheodorou K, Papazoglou D. et al . The new indicator test (Neuropad): a valuable diagnostic tool for small-fiber impairment in patients with type 2 diabetes.  Diabetes Educ. 2007;  33 257-258 260, 262
  • 11 Papanas N, Giassakis G, Papatheodorou K. et al . Use of the new indicator test (Neuropad) for the assessment of the staged severity of neuropathy in type 2 diabetic patients.  Exp Clin Endocrinol Diabetes. 2007b;  115 58-61
  • 12 Papanas N, Papatheodorou K, Papazoglou D. et al . A comparison of the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes.  Exp Clin Endocrinol Diabetes. 2008;  116 135-138
  • 13 Papanas N, Ziegler D. New diagnostic tests for diabetic distal symmetric polyneuropathy.  J Diabetes Complications. 2009;  Nov 5. [Epub ahead of print]
  • 14 Provitera V, Nolano M, Caporaso G. et al . Evaluation of sudomotor function in diabetes using the dynamic sweat test.  Neurology. 2010;  74 50-56
  • 15 Quattrini C, Jeziorska M, Malik RA. Small fiber neuropathy in diabetes: clinical consequence and assessment.  Int J Low Extrem Wounds. 2004;  3 16-21
  • 16 Quattrini C, Jeziorska M, Tavakoli M. et al . The Neuropad test: a visual indicator test for human diabetic neuropathy.  Diabetologia. 2008;  51 1046-1050
  • 17 Rota E, Quadri R, Fanti E. et al . Electrophysiological findings of peripheral neuropathy in newly diagnosed type II diabetes mellitus.  J Peripher Nerv Syst. 2005;  10 348-353
  • 18 Smith AG, Ramachandran P, Tripp S. et al . Epidermal nerve innervation in impaired glucose tolerance and diabetes-associated neuropathy.  Neurology. 2001;  57 1701-1704
  • 19 Spallone V, Morganti R, Siampli M. et al . Neuropad as a diagnostic tool for diabetic autonomic and sensorimotor neuropathy.  Diabet Med. 2009;  26 686-692
  • 20 Sumner CJ, Sheth S, Griffin JW. et al . The spectrum of neuropathy in diabetes and impaired glucose tolerance.  Neurology. 2003;  60 108-111
  • 21 Sun PC, Lin HD, Jao SH. et al . Thermoregulatory sudomotor dysfunction and diabetic neuropathy develop in parallel in at-risk feet.  Diabet Med. 2008;  25 413-418
  • 22 Tentolouris N, Achtsidis V, Marinou K. et al . Evaluation of the self-administered indicator plaster Neuropad for the diagnosis of neuropathy in diabetes.  Diabetes Care. 2008;  31 236-237
  • 23 Tentolouris N, Marinou K, Kokotis P. et al . Sudomotor dysfunction is associated with foot ulceration in diabetes.  Diabet Med. 2009;  26 302-305
  • 24 Tentolouris N, Voulgari C, Liatis S. et al . Moisture status of the skin of the feet assessed by the visual test Neuropad correlates with foot ulceration in diabetes.  Diabetes Care. 2010;  33 1112-1114
  • 25 Valk GD, Nauta JJP, Strijers RLM. et al . Clinical examination versus neurophysiological examination in the diagnosis of diabetic polyneuropathy.  Diabet Med. 1992;  9 716-721
  • 26 Várkonyi T, Kempler P. Diabetic neuropathy: new strategies for treatment.  Diabetes Obes Metab. 2008;  10 99-108
  • 27 Yagihashi S, Yamagishi S, Wada R. Pathology and pathogenetic mechanisms of diabetic neuropathy: correlation with clinical signs and symptoms.  Diabetes Res Clin Pract. 2007;  77 (Suppl. 1) S184-S189
  • 28 Young MJ, Boulton AJM, McLeod AF. et al . A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population.  Diabetologia. 1993;  36 150-154
  • 29 Zick R, Schäper T, Deeters U. Early detection of peripheral neuropathy. Measurement of perspiration in the diabetic foot.  Klinikarzt. 2003;  32 192-194
  • 30 Ziegler D, Siekierka-Kleiser E, Meyer B. et al . Validation of a novel screening device (NeuroQuick) for quantitative assessment of small fiber dysfunction as an early feature of diabetic polyneuropathy.  Diabetes Care. 2005;  28 1169-1174
  • 31 Ziegler D, Mayer P, Mühlen H. et al . The natural history of somatosensory and autonomic nerve dysfunction in relation to glycaemic control during the first 5 years after diagnosis of Type 1 (insulin-dependent) diabetes mellitus.  Diabetologia. 1991;  34 822-829

Correspondence

Dr. N. Papanas

G. Kondyli 22

Alexandroupolis 68100

Greece

Phone: +30/25/5108 4972

Fax: +30/25/5107 4723

Email: papanasnikos@yahoo.gr

    >