The article titled “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” (Zografou et al., 2019) aims to evaluate the effectiveness of Neuropad® in diagnosing Diabetic Peripheral Neuropathy (DPN) in patients with Diabetes Mellitus (DM).
In a cohort of 174 patients with long-standing diabetes (mean duration ~17 years, mean age ~50), Zografou et al. assessed the diagnostic performance of several tools for diabetic peripheral neuropathy: the Michigan Neuropathy Screening Instrument (MNSI), 10 g monofilament testing, biothesiometer-measured vibration perception threshold (VPT), and the sudomotor indicator plaster, Neuropad. Neuropad identifies sudomotor dysfunction-the impairment of sweat gland innervation-by exhibiting an incomplete or absent colour change when applied to the foot.
Using Neuropad, subjects were classified as having normal perspiration (complete blue-to-pink transition) or abnormal sudomotor response. The comparative outcomes were striking: Neuropad exhibited exceptional sensitivity-95% compared to monofilament testing, and 73% relative to both VPT and MNSI-indicating it reliably flagged neuropathy. Specificity ranged between 69% (monofilament) and up to 92% (against MNSI questionnaire), yielding high overall accuracy (76-83%) across comparisons.
These results affirm Neuropad’s clinical value as a screening tool: its high sensitivity ensures most neuropathic patients are correctly identified, while moderate specificity remains acceptable in early detection settings where false negatives are more consequential than false positives. Additionally, Neuropad is both non-invasive and user-friendly, making it an attractive adjunct or alternative to more conventional sensory-based tests.
While the MNSI, monofilament and VPT target large-fibre or sensory neuropathy, Neuropad notably addresses small-fibre and autonomic dysfunction-often overlooked in screening algorithms. By capturing this dimension, Neuropad not only diversifies the neurological assessment toolkit but also potentially identifies impairments earlier in the neuropathic cascade.
In summary, Zografou et al. offer compelling evidence that Neuropad is a rigorously validated, sensitive, and practical test that complements traditional neuropathy diagnostics. Its ease of use and strong predictive performance make it well-suited for routine clinical deployment-particularly in early-stage diabetes care, where timely identification of nerve dysfunction can prompt interventions that may prevent progression and improve long-term outcomes.