Early identification of peripheral neuropathy based on sudomotor dysfunction in Mexican patients with type 2 diabetes

Abstract

Abstract Background Type 2 Diabetes in Mexico has a high prevalence, 16–87% of patients may experience peripheral neuropathy. Early detection can prevent or halt its progression. The performance of Sudoscan in detecting neuropathy was compared to the Michigan Neuropathy Screening Instrument (MNSI). The aim was to identificate small fibers neuropathy. Methods Patients type 2 diabetes received both MNSI and sudomotor function assessment through measurement of electrochemical skin conductance (ESC) in the hands and feet. Results Two hundred twenty-one patients with neuropathy according to MNSI B had lower hands and feet ESC, regardless of diabetes duration. Among the 170 patients who had had diabetes for at least 5 years, 76 of them with normal MNSI B had abnormal hands or feet ESC; this was also the case in 28 out of 51 patients with diabetes than 5 or more years. In contrast, only 5 patients in the first group and 1 in the second group had abnormal MNSI B with normal ESC. Using MNSI B as a reference, abnormal hands or feet ESC (< 60 μS and 70 μS respectively) had a sensitivity of 97%, positive predictive value of 87% to detect neuropathy in patients with longer diabetes duration. The group with shorter diabetes duration, the sensitivity of abnormal hands or feet ESC to detect neuropathy was 91% while the positive predictive value was 88%. Conclusions The Sudoscan device, which does not require any preparation, is noninvasive, easy and rapid to perform, can be useful in the early diagnosis peripheral neuropathy in type 2 diabetic.

Keywords

• MNSI
• Electrochemical skin conductances
• Small fiber neuropathies
• Diabetic neuropathy