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Validity of a point-of-care nerve conduction device for polyneuropathy identification in older adults with diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes.

ABSTRACT: Point-of-care nerve conduction devices (POCD) have been studied in younger patients and may facilitate screening for polyneuropathy in non-specialized clinical settings. However, performance may be impaired with advanced age owing to age-related changes in nerve conduction. We aimed to evaluate the validity of a POCD as a proxy for standard nerve conduction studies (NCS) in older adults with type 1 diabetes (T1D).Sural nerve amplitude potential (AMP) and sural nerve conduction velocity (CV) was measured in 68 participants with ? 50 years T1D duration and 71 controls (from age/sex-matched subgroups) using POCD and NCS protocols. Agreement was determined by the Bland-Altman method, and validity was determined by receiver operating characteristic curves.T1D were 53% female, aged 66±8yr and had diabetes duration 54yr[52,58]. Controls were 56%(p = 0.69) female and aged 65±8yr(p = 0.36). Mean AMPPOCD and CVPOCD for the 139 participants was 7.4±5.8?V and 45.7±11.2m/s and mean AMPNCS and CVNCS was 7.2±6.1?V and 43.3±8.3m/s. Mean difference of AMPPOCD-AMPNCS was 0.3±3.8?V and was 2.3±8.5m/s for CVPOCD-CVNCS. A AMPPOCD of ?6?V had 80% sensitivity and 80% specificity for identifying abnormal AMPNCS, while a CVPOCD of ?44m/s had 81% sensitivity and 82% specificity to identify abnormal CVNCS. Abnormality in AMPPOCD or CVPOCD was associated with 87% sensitivity, while abnormality in both measures was associated with 97% specificity for polyneuropathy identification.The POCD has strong agreement and diagnostic accuracy for identification of polyneuropathy in a high-risk subgroup and thus may represent a sufficiently accurate and rapid test for routinely detecting those with electrophysiological dysfunction.

SUBMITTER: Scarr D

PROVIDER: S-EPMC5927425 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Validity of a point-of-care nerve conduction device for polyneuropathy identification in older adults with diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes.

Scarr Daniel D Lovblom Leif E LE Cardinez Nancy N Orszag Andrej A Farooqi Mohammed A MA Boulet Genevieve G Weisman Alanna A Lovshin Julie A JA Ngo Mylan M Paul Narinder N Keenan Hillary A HA Brent Michael H MH Cherney David Z DZ Bril Vera V Perkins Bruce A BA

PloS one 20180430 4

<h4>Objective</h4>Point-of-care nerve conduction devices (POCD) have been studied in younger patients and may facilitate screening for polyneuropathy in non-specialized clinical settings. However, performance may be impaired with advanced age owing to age-related changes in nerve conduction. We aimed to evaluate the validity of a POCD as a proxy for standard nerve conduction studies (NCS) in older adults with type 1 diabetes (T1D).<h4>Methods</h4>Sural nerve amplitude potential (AMP) and sural n ...[more]

PMID: 29709021

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Project description:BackgroundCurrently, no international diagnostic criteria for diabetic neuropathy (DN) have been established. Recently, a novel point-of-care sural nerve conduction device has been developed. We aimed to investigate associations between DN and clinical parameters related to the development and progression of DN by using this novel device.MethodsWe conducted a retrospective observational study in patients with diabetes whose sural nerve functions were measured using DPN Check between January 2015 and October 2016. Multiple and logistic regression analyses were conducted to assess the associations of sural nerve conduction velocity (SNCV) and amplitude (SNAP) with clinical parameters related to DN.ResultsA total of 740 patients were enrolled in this study. At baseline, 211 patients were diagnosed with DN by using DPN Check. The sensitivity, specificity, and positive likelihood ratio of DPN Check compared with ankle reflex as reference were 81%, 46%, and 1.5, respectively. Of these, 182 patients were followed up for approximately 1 year to measure changes in SNCV and SNAP. Both SNCV and SNAP were inversely associated with duration of diabetes, plasma glucose levels, and hemoglobin A1c levels at baseline, whereas these were positively associated with ankle-brachial index. Logistic regression analysis revealed that poor glycemic control was associated with increased risk of reduction in both SNCV [odds ratio = 1.570; 95% confidence interval (CI) = 1.298-1.898; p < 0.001] and SNAP (odds ratio = 1.408; 95% CI = 1.143-1.735; p = 0.001), and longer duration of diabetes was also significantly associated with an increased risk of reduction in both SNCV (odds ratio = 1.058; 95% CI = 1.032-1.084; p < 0.001) and SNAP (odds ratio = 1.049; 95% CI = 1.019-1.079; p = 0.001).ConclusionSural nerve functions were significantly associated with glycemic control and arteriosclerosis in patients with diabetes. DPN Check may be useful as a screening tool to identify DN in clinical practice.

Project description:IntroductionThe Diabetes Injection Device Preference Questionnaire (DID-PQ) was designed to assess patient preference between two non-insulin injection devices. In a recent crossover study, people with type 2 diabetes (T2D) completed the DID-PQ after performing mock injections with two non-insulin injection devices. The purpose of the current analysis was to use these data to assess construct validity of the DID-PQ and demonstrate one way to test whether there is a significant preference for one injection device over another.MethodsData were from an open-label, multicenter, randomized, crossover study assessing preference between the dulaglutide and semaglutide injection pens. In addition to the 10-item DID-PQ, people with T2D completed a global item assessing overall preference. DID-PQ responses were compared to the global preference item (percent agreement, Gwet's AC1, prevalence-adjusted and bias-adjusted Kappa [PABAK]). For each item of the DID-PQ, a two-sided binomial test assessed whether the difference in preference was statistically significant.ResultsThe sample included 310 participants (48.4% female; mean age = 60.0). The DID-PQ had minimal missing data. There was strong concordance (percent agreement > 78%) between the global preference item and all DID-PQ items except item 6, which assesses preference related to needle size (59.7%). The Gwet AC1 and PABAK statistics also indicated strong agreement between the global preference item and all DID-PQ items except item 6. There was a statistically significant difference (p < 0.0001) in preference on every DID-PQ item, with more participants preferring the dulaglutide device.DiscussionPatient preference has been recommended as a "major factor driving the choice of medication" in a consensus report by the American Diabetes Association and the European Association for the Study of Diabetes. Current findings suggest that the DID-PQ may be a useful tool for providing insight into preferences of people with T2D using non-insulin injectable medication.

Dataset Information

Validity of a point-of-care nerve conduction device for polyneuropathy identification in older adults with diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes.

Publications

Validity of a point-of-care nerve conduction device for polyneuropathy identification in older adults with diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes.

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