The University of Liverpool has published a report “Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres” which emphasises the connection between small fibre damage and sudomotor dysfunction, and proposes the use of Neuropad as a screening test.
This comprehensive review addresses the critical shortcomings of conventional diabetic neuropathy screening tools-such as monofilaments and tuning forks-which largely identify advanced large‑fibre dysfunction and fail to detect early, reversible small‑fibre injury. The authors emphasise that early diabetic peripheral neuropathy (DPN) typically begins with degeneration of small, unmyelinated nerve fibres. Consequently, they appraise a spectrum of emerging diagnostic modalities designed to detect such subtle changes, ranging from skin biopsy to non‑invasive imaging and functional assays.
Among the gold‑standard approaches, corneal confocal microscopy (CCM) stands out for its rapid, reproducible quantification of small‑fibre density in the cornea. CCM not only enables early DPN detection but also proves capable of predicting future neuropathy development and allowing longitudinal staging with high objectivity. However, this and other advanced techniques, while promising, can be expensive, require specialist infrastructure, and may not be suitable for routine clinical screening.
Other non‑invasive or minimally invasive candidates include quantitative sensory testing, sudomotor assays, and point‑of‑care nerve conduction studies. Most alternative tests falter due to subjective interpretation, technical complexity, or limited evaluation of autonomic fibres. In this context, sudomotor testing-assessing sweat gland innervation through simple skin responses-emerges as a strategy of particular interest. Tools such as Neuropad (a visual indicator plaster that gauges sweat output) exemplify this modality. Although not the review’s central focus, Neuropad represents an accessible functional biomarker of small‑fibre and autonomic compromise.
The review underscores that early identification of small‑fibre neuropathy opens a therapeutic window. When caught early, lifestyle interventions-such as tailored diet and structured exercise-can effectively reverse or slow disease progression. Hence, the overarching priority is to integrate reliable, scalable, and user‑friendly screening tools into routine diabetic care-all ideally suited for smooth translation into broad, population‑level programs akin to retinopathy or nephropathy screening.
Neuropad merits mention in this context: as an uncomplicated, point‑of‑care sudomotor test, it holds promise as a pragmatic instrument for early DPN detection. While the MDPI review highlighted corneal microscopy as one of the most powerful early‑detection methods, it also implicitly sets the stage for tools like Neuropad that assess autonomic small‑fibre function in a low‑cost, clinic‑ or home‑based format.
Neuropad exemplifies the type of simple, scalable test the authors argue we urgently need-one that can flag early neuropathic changes and thereby enable timely, multifactorial interventions to forestall irreversible nerve damage and its associated complications.
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Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres