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

11 Citations (Scopus)

Abstract

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
Volume31
Issue number12
DOIs
Publication statusPublished - 1 Dec 2014
Externally publishedYes

Fingerprint

Diabetic Neuropathies
Nerve Fibers
Peroneal Nerve
Neural Conduction
Peripheral Nervous System Diseases
Vibration
Sensitivity and Specificity
Sweating
Symptom Assessment
Routine Diagnostic Tests
Cholinergic Agents
Area Under Curve
Small Fiber Neuropathy

ASJC Scopus subject areas

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

Cite this

The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy. / Ponirakis, Georgios; Petropoulos, I. N.; Fadavi, H.; Alam, U.; Asghar, O.; Marshall, A.; Tavakoli, M.; Malik, Rayaz.

In: Diabetic Medicine, Vol. 31, No. 12, 01.12.2014, p. 1673-1680.

Research output: Contribution to journalArticle

Ponirakis, G, Petropoulos, IN, 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, vol. 31, no. 12, pp. 1673-1680. https://doi.org/10.1111/dme.12536
Ponirakis, Georgios ; Petropoulos, I. N. ; Fadavi, H. ; Alam, U. ; Asghar, O. ; Marshall, A. ; Tavakoli, M. ; Malik, Rayaz. / The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy. In: Diabetic Medicine. 2014 ; Vol. 31, No. 12. pp. 1673-1680.
@article{505155b4127940c98c1ea7ada9f432e0,
title = "The diagnostic accuracy of Neuropad{\circledR} for assessing large and small fibre diabetic neuropathy",
abstract = "Aims: Neuropad{\circledR} 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.",
author = "Georgios Ponirakis and Petropoulos, {I. N.} and H. Fadavi and U. Alam and O. Asghar and A. Marshall and M. Tavakoli and Rayaz Malik",
year = "2014",
month = "12",
day = "1",
doi = "10.1111/dme.12536",
language = "English",
volume = "31",
pages = "1673--1680",
journal = "Diabetic Medicine",
issn = "0742-3071",
publisher = "Wiley-Blackwell",
number = "12",

}

TY - JOUR

T1 - The diagnostic accuracy of Neuropad® for assessing large and small fibre diabetic neuropathy

AU - Ponirakis, Georgios

AU - Petropoulos, I. N.

AU - Fadavi, H.

AU - Alam, U.

AU - Asghar, O.

AU - Marshall, A.

AU - Tavakoli, M.

AU - Malik, Rayaz

PY - 2014/12/1

Y1 - 2014/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=84911440067&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84911440067&partnerID=8YFLogxK

U2 - 10.1111/dme.12536

DO - 10.1111/dme.12536

M3 - Article

VL - 31

SP - 1673

EP - 1680

JO - Diabetic Medicine

JF - Diabetic Medicine

SN - 0742-3071

IS - 12

ER -