The article titled “Concordance between sudomotor disorder and the clinical diagnosis of diabetic peripheral neuropathy, according to various clinical guidelines” (Chicharro-Luna et al., 2021) explores the concordance between variations in Neuropad® results and the different diagnostic criteria of Diabetic Peripheral Neuropathy (DPN) as per different clinical guidelines.
The study involved 111 patients with a confirmed diagnosis of diabetes mellitus.
- The degree of metabolic control was determined according to the last analysis performed in the previous six months (blood glucose, glycated haemoglobin (HbA1c), triglycerides, total cholesterol, high-density lipoproteins (HDL) cholesterol, low-density lipoproteins (LDL) cholesterol, creatinine).
- The following comorbidities were recorded: high blood pressure, coronary heart disease, cerebrovascular diseases, nephropathy, retinopathy and/or cancer. To detect the presence of the risk factor of smoking, patients were asked if they were or had been smokers
- The possible presence of peripheral artery disease was determined by calculating the ankle-brachial index with a bidirectional Smartdop 45 Hadeco Doppler probe.
- The presence / absence of DPN was determined according to five criteria stipulated in various clinical guidelines (ADA 2018, IWGDF2016, IDF 2012)[1].
- The clinical examination was conducted by applying a 5.07 Sensifil monofilament perpendicular to the skin.
- Vibratory sensitivity was assessed on a scale ranging from 0 to 8, using a 128 Hz Rydel-Seiffer tuning fork.
- Sensitivity to pain was explored using the Neuropen®, an instrument that presents a blunt non-puncturing tip attached to a base (lancet), with a spring that exerts a pressure of 40 g, sufficient to provoke a painful stimulus.
- The Achilles reflex was examined by tapping the Achilles tendon with a rubber hammer, with the knee flexed and resting on a surface, to determine the presence of plantar flexion in the foot.
- Finally, sudomotor dysfunction was assessed by the application of Neuropad®, placed in the plantar area of the foot, between the first and second metatarsophalangeal joints, avoiding areas of hyperkeratosis. The test was performed indoors, at a temperature of 20−25◦C, for ten minutes, after which the colour change was assessed.
The results showed that Neuropad® is an effective tool for detecting early-stage neuropathy and other complications related to macro and microvascular issues. The study points out that its use should always be accompanied by a clinical examination of the foot. The article highlights the importance of identifying DPN to stratify the risk and prevent foot ulceration in patients with diabetes.