The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy

Georgios Ponirakis, I. N. Petropoulos, H. Fadavi, U. Alam, O. Asghar, A. Marshall, M. Tavakoli, Rayaz Malik

Research output: Contribution to journalArticle

15 Citations (Scopus)


Aims: Neuropad® is a simple visual indicator test, with moderate diagnostic performance for diabetic peripheral neuropathy. As it assesses sweating, which is a measure of cholinergic small nerve fibre function, we compared its diagnostic performance against established measures of both large and, more specifically, small fibre damage in patients with diabetes. Methods: One hundred and twenty-seven participants (89 without diabetic peripheral neuropathy and 38 with) aged 57 ± 9.7 years underwent assessment with Neuropad, large nerve fibre assessments: Neuropathy Disability Score, vibration perception threshold, peroneal motor nerve conduction velocity; small nerve fibre assessments: neuropathy symptoms (Diabetic Neuropathy Symptoms score) corneal nerve fibre length and warm perception threshold. Results: Neuropad has a high sensitivity but moderate specificity against large fibre neuropathy assessments: Neuropathy Disability Score (> 2) 70% and 50%, vibration perception threshold (> 14 V) 83% and 53%, and peroneal motor nerve conduction velocity (< 42 m/s) 81% and 54%, respectively. However, the diagnostic accuracy of Neuropad was significantly improved against corneal nerve fibre length (< 14 mm/mm2) with a sensitivity and specificity of 83% and 80%, respectively. Furthermore, the area under the curve for corneal nerve fibre length (85%) was significantly greater than with the Neuropathy Disability Score (66%, P = 0.01) and peroneal motor nerve conduction velocity (70%, P = 0.03). For neuropathic symptoms, sensitivity was 78% and specificity was 60%. Conclusions: The data show the improved diagnostic performance of Neuropad against corneal nerve fibre length. This study underlines the importance of Neuropad as a practical diagnostic test for small fibre neuropathy in patients with diabetes.

Original languageEnglish
Pages (from-to)1673-1680
Number of pages8
JournalDiabetic Medicine
Issue number12
Publication statusPublished - 1 Dec 2014
Externally publishedYes

ASJC Scopus subject areas

  • Endocrinology
  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

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    Ponirakis, G., Petropoulos, I. N., Fadavi, H., Alam, U., Asghar, O., Marshall, A., Tavakoli, M., & Malik, R. (2014). The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy. Diabetic Medicine, 31(12), 1673-1680.