Clinical studies

Recognising the value of the sudomotor function test

Before exploring the robust clinical data backing the Neuropad® 10-Minute Screening Test®, it’s important to consider the significant and long-established body of evidence highlighting that:

  • sudomotor function testing is a powerful predictor of serious diabetes-related foot complications—including ulcers and amputations
  • diabetic peripheral neuropathy is a major complication in both type 1 and type 2 diabetes and can occur early, even before hyperglycaemia
  • testing for signs of small nerve fibre damage can predict diabetes-related foot issues earlier than testing for signs of  large fibre damage.
March 1, 2009A close-up picture of a sweating hand

Sudomotor dysfunction is an early detectable abnormality in distal small fibre neuropathy

Illigens B.M.W., Gibbons C.H. (2009)

December 20, 2018A picture of an alarm clock

Advantages of early diagnosis of diabetic neuropathy

Sanz-Corbalán I., Lázaro-Martínez J.L., García-Morales E. et al. (2018)

July 7, 2011A close-up picture of a cornea

The role of small fibre neuropathy in the diagnosis of diabetic polyneuropathy

Malik R., Veves A., Tesfaye S. et al. (2011)

May 1, 2017Close-up illustration of nerve networks

Diabetic peripheral neuropathy is a major complication in type 1 and 2 diabetes

Duarte J. (2017)

February 1, 2021Clockwork machinery, depicting accuracy

Early detection of diabetic peripheral neuropathy: a focus on small nerve fibres

Burgess J., Frank B., Marshall A. et al (2021)

Clinical validation: the science behind Neuropad®

Neuropad® stands out as a clinically sound, non-invasive tool that reliably detects early diabetic neuropathy by assessing sudomotor function. Its high sensitivity, particularly for small-fibre and autonomic nerve damage, enables accurate prediction of complications such as foot ulcers.

The simplicity and ease of self-administration of Neuropad® facilitate widespread screening in diverse settings, from outpatient clinics to care homes and because it is entirely objective and therefore easy to interpret it can do so regardless of variables such as language and cognition with near 100% clinically proven reproducibility.

Strong concordance with established diagnostic methods underscores its reliability, while its cost-effectiveness supports integration into routine diabetes care, ultimately enhancing early diagnosis and timely intervention to reduce morbidity.

July 11, 2025A Neuropad screening test

High Diagnostic Performance of the Indicator Plaster Neuropad for the Detection of Established Diabetic Autonomic Neuropathy

Zografou, I., Doukelis P., Koufakis T. (2025)

July 8, 2005Neuropad reproducible

Test–retest reproducibility of Neuropad® found to be robust

Papanas N., Papatheodorou K., Papazoglou D. et al. (2005)

August 11, 2008Scrabble letters spelling out the word EASY, to illustrate the proven ease of use of Neuropad 10-Minute screening test

Neuropad® user experience found to be simple to use for self-administration

Tentolouris N., Achtsidis V., Marinou K. et al (2008)

September 8, 2008A magnifying glass being used to magnify a view of nerve tissue (illustration)

Neuropad®: A reliable, non-invasive tool for early detection of diabetic neuropathy

Quattrini C., Jeziorska M., Tavakoli M. et al. (2008)

November 3, 2010Schematic of a blue / pink Neuropad patch with the Neuropad logo on top

Diagnosis of diabetic neuropathy using simple somatic and a new autonomic (Neuropad®) tests in the clinical practice

Kamenov Z.A., Petrova J.J., Christov V.G. (2010)

November 24, 2011Clockwork machinery, depicting accuracy

Accuracy of the Neuropad® Test for the Diagnosis of Distal Symmetric Polyneuropathy in Type 2 Diabetes

Papanas N., Paschos P., Papazoglou D. et al. (2011)

March 20, 2014Sweets forming the shape of the word diabetes

Study underscores the utility of Neuropad® as a non-invasive, reliable tool for early detection of diabetic neuropathy

Ishibashi F., Kojima R., Kawasaki A. et al. (2014)

July 4, 2014A dart board showing a dart in the bullseye

Neuropad® excels in detecting early small-fibre neuropathy in diabetes

Ponirakis G., Petropoulos I.N., Fadavi H. (2014)

October 8, 2016A flag of Colombia

Neuropad® detects hidden autonomic nerve damage in Colombian patients with type 2 diabetes

Mendivil C.O., William Kattah W., Orduz A. et al. (2016)

October 18, 2019A 10mg monofilament, a Neuropad 10-Minute Screening Test and a biothesiometer

Comparing Neuropad® to the 10g monofilament and biothesiometer

Zografou I., Iliadis F., Sambanis C. et al (2019)

July 8, 2020A number of ten pound notes

Use of Neuropad® as a screening test shown to be highly cost-effective

Rodríguez-Sánchez, B., Peña-Longobardo L. M., Sinclair A.J. (2020)

September 2, 2020A cracked and dried river bed with the Neuropad logo overlaid

In prospective observational study, Neuropad® detects foot skin dryness, predicting diabetic foot ulcer risk early and accurately

Panagoulias G., Eleftheriadou I., Papanas N. et al. (2020)

November 25, 2021Veins of a leaf, used to represent the vascular structures of the human body

Neuropad® and clinical guidelines align to enhance early detection of diabetic peripheral neuropathy

Chicharro-Luna E., Ortega-Avila A.B., Requena-Martínez A. et al. (2021)

June 30, 2022A woman sits smiling behind a bouquet of flowers

Neuropad® 10-Minute Screening Test® recommended for use in a care home setting

Sinclair A. et al. (2022)

A full list of published clinical studies

  1. de Azevedo Vieira, A.R.S., Porto-Dantas, L.B., do Prado Romani, F.A. et al. Autonomic neuropathic symptoms in patients with diabetes: practical tools for screening in daily routine Diabetol Metab Syndr 15, 83 (2023).
  2. Mendivil CO, Kattah W, Orduz A, Tique C, Cárdenas JL, Patiño JE. Neuropad for the detection of cardiovascular autonomic neuropathy in patients with type 2 diabetes. J Diabetes Complications. 2015 Oct 14. pii: S1056-8727(15)00394-3. doi: 10.1016/j.jdiacomp.2015.10.004. [Epub ahead of print]
  3. Ponirakis G, Fadavi H, Petropoulos IN, Azmi S, Ferdousi M, Dabbah MA, Kheyami A, Alam U, Asghar O, Marshall A, Tavakoli M, Al-Ahmar A, Javed S, Jeziorska M, Malik RA. Automated quantification of Neuropad improves its diagnostic ability in patients with diabetic neuropathy. J Diabetes Res. 2015;2015:847-54.
  4. Ishibashi F, Kojima R, Kawasaki A, Yamanaka E, Kosaka A, Uetake H. Correlation between sudomotor function, sweat gland duct size and corneal nerve fiber pathology in patients with type 2 diabetes mellitus. J Diabetes Investig. 2014 Sep;5(5):588-96.
  5. Ponirakis G, Petropoulos IN, Fadavi H, Alam U, Asghar O, Marshall A, Tavakoli M, Malik RA. The diagnostic accuracy of Neuropad for assessing large and small fibre diabetic neuropathy.Diabet Med. 2014 Dec;31(12):1673-80.
  6. Papanas N, Ziegler D. New vistas in the diagnosis of diabetic polyneuropathy. Endocrine. 2014 Dec;47(3):690-8. Review.
  7. Qin Y, Cao Y, Gao F, Luo X, Li J, Fu X, Xue Y. Neuropad test for sudomotor function to predict the risk of diabetic foot ulceration Nan Fang Yi Ke Da Xue Xue Bao. 2014 Apr;34(4):560-2. Chinese.
  8. Manes C, Papanas N, Exiara T, Katsiki N, Papantoniou S, Kirlaki E, Tsotoulidis S, Kefalogiannis N, Maltezos E. The indicator test Neuropad in the assessment of small and overall nerve fibre dysfunction in patients with type 2 diabetes: a large multicentre study. Exp Clin Endocrinol Diabetes. 2014 Mar;122(3):195-9.
  9. Tsapas A, Liakos A, Paschos P, Karagiannis T, Bekiari E, Tentolouris N, Boura P. A simple plaster for screening for diabetic neuropathy: a diagnostic test accuracy systematic review and meta-analysis. Metabolism. 2014 Apr;63(4):584-92. Review.
  10. Tomešová J, Gruberova J, Lacigova S, Cechurova D, Jankovec Z, Rusavy Z. Differences in skin microcirculation on the upper and lower extremities in patients with diabetes mellitus: relationship of diabetic neuropathy and skin microcirculation. Diabetes Technol Ther. 2013 Nov;15(11):968-75.`
  11. Karachristianou S, Papamichalis E, Sarantopoulos A, Boura P, Georgiadis G. Hypohidrosis induced by topiramate in an adult patient.Epileptic Disord. 2013 Jun;15(2):203-6.
  12. Aubert CE, Le Doeuff J, Lajou J, Barthelemy O, Hartemann A, Bourron O. Influence of peripheral arterial occlusive disease on the Neuropad test performance in patients with diabetes. Diabet Med. 2013 May;30(5):e178-84.
  13. Papanas N, Boulton AJ, Malik RA, Manes C, Schnell O, Spallone V, Tentolouris N, Tesfaye S, Valensi P, Ziegler D, Kempler P. A simple new non-invasive sweat indicator test for the diagnosis of diabetic neuropathy. Diabet Med. 2013 May;30(5):525-34. Review.
  14. Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, Aragón-Sánchez J, Carabantes-Alarcón D, García-Álvarez Y. Relationship of limited joint mobility and foot deformities with neurological examination in patients with diabetes. Exp Clin Endocrinol Diabetes. 2013 Apr;121(4):239-43.
  15. Yoshioka K, Okada H. Useful application of the Neuropad test for assessment of diabetic polyneuropathy. Intern Med. 2012;51(23):3241-5.
  16. Vieru A, Niţă O, Graur LI, Mazilu G, Mihalache L, Popescu RM, Graur M. Neuropad test in evaluation of diabetic foot. Rev Med Chir Soc Med Nat Iasi. 2012 Jan-Mar;116(1):90-6. Romanian.
  17. Ziegler D, Papanas N, Rathmann W, Heier M, Scheer M, Meisinger C; KORA Study Group. Evaluation of the Neuropad sudomotor function test as a screening tool for polyneuropathy in the elderly population with diabetes and pre-diabetes: the KORA F4 survey. Diabetes Metab Res Rev. 2012 Nov;28(8):692-7.
  18. Pritchard N, Edwards K, Vagenas D, Russell AW, Malik RA, Efron N. Corneal sensitivity is related to established measures of diabetic peripheral neuropathy. Clin Exp Optom. 2012 May;95(3):355-61.
  19. Datema M, Gert van Dijk J, Hoitsma E. The diagnostic value of water immersion skin wrinkling and Neuropads in small fiber neuropathy. Clin Neurophysiol. 2012 Oct;123(10):2074-9.
  20. Papanas N, Demetriou M, Katsiki N, Papatheodorou K, Papazoglou D, Gioka T, Kotsiou S, Maltezos E, Mikhailidis DP. Increased serum levels of uric acid are associated with sudomotor dysfunction in subjects with type 2 diabetes mellitus. Exp Diabetes Res. 2011;2011:346051.
  21. Ziegler D, Papanas N, Roden M; GDC Study Group. Neuropad: evaluation of three cut-off points of sudomotor dysfunction for early detection of polyneuropathy in recently diagnosed diabetes. Diabet Med. 2011 Nov;28(11):1412-5
  22. Papanas N, Paschos P, Papazoglou D, Papatheodorou K, Paletas K, Maltezos E, Tsapas A. Accuracy of the Neuropad test for the diagnosis of distal symmetric polyneuropathy in type 2 diabetes. Diabetes Care. 2011 Jun;34(6):1378-82.
  23. Argiana V, Eleftheriadou I, Tentolouris N. Screening for the high-risk foot of ulceration: tests of somatic and autonomic nerve function. Curr Diab Rep. 2011 Aug;11(4):294-301.Review.
  24. Papanas N, Papazoglou D, Papatheodorou K, Maltezos E. Evaluation of a new foam to increase skin hydration of the foot in type 2 diabetes: a pilot study. Int Wound J. 2011 Jun;8(3):297-300.
  25. Papanas N, Papatheodorou K, Papazoglou D, Kotsiou S, Maltezos E. A prospective study on the use of the indicator test Neuropad for the early diagnosis of peripheral neuropathy in type 2 diabetes. Exp Clin Endocrinol Diabetes. 2011 Feb;119(2):122-5.
  1. Papanas N, Papatheodorou K, Papazoglou D, Kotsiou S, Maltezos E. J Association between foot temperature and sudomotor dysfunction in type 2 diabetes. Diabetes Sci Technol. 2010 Jul 1;4(4):803-7.
  2. Kamenov ZA, Petrova JJ, Christov VG. Diagnosis of diabetic neuropathy using simple somatic and a new autonomic (Neuropad) tests in the clinical practice. Exp Clin Endocrinol Diabetes. 2010 Apr;118(4):226-33.
  3. Freitas C, Carvalho A, Melo-Rocha G, Amaral C, Pinto S, Guimarães R, Neto H, Suascun J, Muras J, Gonçalves I, Martins J, Dores J, Carvalho R, Borges F. The Neuropadtest in the screening of peripheral neuropathy in diabetic patients. Acta Med Port. 2009 Nov-Dec;22(6):729-34. Portuguese.
  4. Papanas N, Ziegler D. J New diagnostic tests for diabetic distal symmetric polyneuropathy. Diabetes Complications. 2011 Jan-Feb;25(1):44-51.
  5. Tentolouris N, Voulgari C, Liatis S, Kokkinos A, Eleftheriadou I, Makrilakis K, Marinou K, Katsilambros N. Moisture status of the skin of the feet assessed by the visual test Neuropad correlates with foot ulceration in diabetes. Diabetes Care. 2010 May;33(5):1112-4.
  6. Spallone V, Morganti R, Siampli M, Fedele T, D’Amato C, Cacciotti L, Maiello MR. Neuropadas a diagnostic tool for diabetic autonomic and sensorimotor neuropathy. Diabet Med. 2009 Jul;26(7):686-92.
  7. Quattrini C, Jeziorska M, Tavakoli M, Begum P, Boulton AJ, Malik RA. The Neuropad test: a visual indicator test for human diabetic neuropathy. Diabetologia. 2008 Jun;51(6):1046-50.
  8. Papanas N, Papatheodorou K, Papazoglou D, Monastiriotis C, Christakidis D, Maltezos E. A comparison of the new indicator test for sudomotor function (Neuropad) with the vibration perception threshold and the clinical examination in the diagnosis of peripheral neuropathy in subjects with type 2 diabetes. Exp Clin Endocrinol Diabetes. 2008 Feb;116(2):135-8.
  9. Tentolouris N, Achtsidis V, Marinou K, Katsilambros N. Evaluation of the self-administered indicator plaster Neuropad for the diagnosis of neuropathy in diabetes.Diabetes Care. 2008 Feb;31(2):236-7.
  10. Bilen H, Atmaca A, Akcay G. Neuropad indicator test for diagnosis of sudomotor dysfunction in type 2 diabetes. Adv Ther. 2007 Sep-Oct;24(5):1020-7.
  11. Papanas N, Giassakis G, Papatheodorou K, Papazoglou D, Monastiriotis C, Christakidis D, Piperidou H, Maltezos E. J Sensitivity and specificity of a new indicator test (Neuropad) for the diagnosis of peripheral neuropathy in type 2 diabetes patients: a comparison with clinical examination and nerve conduction study. Diabetes Complications. 2007 Nov-Dec;21(6):353-8.
  12. Shen J, Cao Y, Han YJ, Luo XR, Xie CH, Li JM, Xue YM. Sweat function evaluation for early diagnosis of diabetic peripheral neuropathy. Nan Fang Yi Ke Da Xue Xue Bao. 2007 Aug;27(8):1210-2. Chinese.
  13. Eckhard M, Lengler A, Liersch J, Bretzel RG, Mayser P. Fungal foot infections in patients with diabetes mellitus–results of two independent investigations. Mycoses. 2007;50 Suppl 2:14-9.
  14. Jirkovská A, Boucek P. Examination of tactile disorders in diabetic patients and cooperation with a neurologist. Vnitr Lek. 2007 May;53(5):489-94. Review. Czech.
  15. Papanas N, Papatheodorou K, Papazoglou D, Christakidis D, Monastiriotis C, Maltezos E. The new indicator test (Neuropad): a valuable diagnostic tool for small-fiber impairment in patients with type 2 diabetes. Diabetes Educ. 2007 Mar-Apr;33(2):257-8, 260, 262 passim.
  16. Papanas N, Giassakis G, Papatheodorou K, Papazoglou D, Monastiriotis C, Christakidis D, Piperidou H, Maltezos E. Use of the new indicator test (Neuropad) for the assessment of the staged severity of neuropathy in type 2 diabetic patients. Exp Clin Endocrinol Diabetes. 2007 Jan;115(1):58-61.
  17. Papanas N, Papatheodorou K, Papazoglou D, Christakidis D, Monastiriotis C, Maltezos E. Reproducibility of the new indicator test for sudomotor function (Neuropad) in patients with type 2 diabetes mellitus: short communication. Exp Clin Endocrinol Diabetes. 2005 Dec;113(10):577-81.
  18. Papanas N, Papatheodorou K, Christakidis D, Papazoglou D, Giassakis G, Piperidou H, Monastiriotis C, Maltezos E. Evaluation of a new indicator test for sudomotor function (Neuropad) in the diagnosis of peripheral neuropathy in type 2 diabetic patients. Exp Clin Endocrinol Diabetes. 2005 Apr;113(4):195-8.
  19. Fernández-Torres R, Ruiz-Muñoz M, Pérez-Panero AJ, García-Romero J, Gónzalez-Sánchez M. Instruments of Choice for Assessment and Monitoring Diabetic Foot: A Systematic Review. J Clin Med. 2020 Feb 24;9(2):602.
  20. Burgess J, Frank B, Marshall A et al. Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres. Diagnostics 2021, 11, 165.
  21. Zografou I, Iliadis F, Sambanis C, Didangelos T. Validation of Neuropad in the Assessment of Peripheral Diabetic Neuropathy in Patients with Diabetes Mellitus Versus the Michigan Neuropathy Screening Instrument, 10g Monofilament Application and Biothesiometer Measurement. Curr Vasc Pharmacol. 2020;18(5):517-522. doi: 10.2174/1570161117666190723155324.
  22. Rodríguez-Sánchez B, L. Peña-Longobardo M, Sinclair A J. Cost-effectiveness analysis of the Neuropad
    device as a screening tool for early diabetic peripheral neuropathy. Eur J Health Econ DOI 10.1007/s10198-019-01134-2
  23. Panagoulias GS, Eleftheriadou I, Papanas N, et al. Dryness of Foot Skin Assessed by the Visual Indicator Test and Risk of Diabetic Foot Ulceration: A Prospective Observational Study. Front. Endocrinol. Published online 08 September 2020
  24. Sanz-Corbalán I, Lázaro-Martínez JL, García-Morales E, et al. Advantages of early diagnosis of diabetic neuropathy in the prevention of diabetic foot ulcers. Diabetes Res Clin Pract. 2018;146:148–154.