Quick and simple evaluation of sudomotor function for screening of diabetic neuropathy

Chittaranjan S Yajnik, Vaishali V Kantikar, Amol J Pande, Jean P Deslypere, Chittaranjan S Yajnik, Vaishali V Kantikar, Amol J Pande, Jean P Deslypere

Abstract

Objective. The aim of this study was to compare SUDOSCAN, a new device to evaluate sweat function (reflecting peripheral small C-fiber status), with conventional measures of peripheral and cardiac neuropathy in patients with type 2 diabetes. Methods. 265 diabetic patients were tested for symptoms and clinical signs of neuropathy using Michigan Neuropathy Screening Instrument (MNSI), vibration perception threshold (VPT) using biothesiometer, and cardiac autonomic neuropathy (CAN) using Ewing's protocol. Sudomotor function was investigated with SUDOSCAN through measurement of electrochemical skin conductance (ESC) of hands and feet. Lower ESC is suggestive of sudomotor dysfunction. Results. Lower ESC at feet was significantly associated both with increasing symptoms (MNSI A) and increasing score on physical abnormalities (MNSI B). Lower ESC at feet was also significantly associated with increasing VPT by biothesiometry (P < 0.01), and with higher number of abnormal CAN results (P < 0.05). ESC was associated with postural fall in blood pressure (sympathetic abnormality) (P < 0.05), but not with heart rate variability (HRV) tests (parasympathetic abnormalities). Conclusions. Sudomotor dysfunction testing may be a simple test to alert physicians to peripheral nerve and cardiac sympathetic dysfunction. Ease of performance could make it useful in a busy diabetic clinic. Further studies with hard clinical outcomes are indicated.

Figures

Figure 1
Figure 1
General presentation of the SUDOSCAN with the hands and feet electrodes and the master unit.
Figure 2
Figure 2
Agreement plot between left and right side measurements of ESC in feet using SUDOSCAN and vibration perception threshold (VPT) using biothesiometer. Figure shows a closer agreement in the ESC measurements compared to the VPT measurements.
Figure 3
Figure 3
Figure shows association between Michigan Neuropathy Screening Instrument B (MNSI B) and Electrochemical Skin Conductance (ESC) in foot (SUDOSCAN). Increasing MNSI B was associated with decreasing ESC (P < 0.01). Each bar represents mean ± (SE *1.96).
Figure 4
Figure 4
Figure shows association between vibration perception threshold (VPT) (biothesiometry) and electrochemical skin conductance (ESC) in foot (SUDOSCAN). Increasing VPT was associated with decreasing ESC (P < 0.01). Each bar represents mean ± (SE *1.96).

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