Dataset Information

Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus.

ABSTRACT:

Aims

Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time-consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point-of-care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN.

Methods

Nerve amplitude (AMP_POCD ) and conduction velocity (CV_POCD ) were measured in a cross-sectional study including 198 asymptomatic patients with type 1 diabetes. CAN was diagnosed by the Ewing score and power spectral heart rate [low-frequency (LF) and high-frequency (HF) activity]. Diagnostic accuracy was determined by ROC curves.

Results

CV_POCD and AMP_POCD showed positive correlations with LF and HF, and a negative correlation with age. Overall, AMP_POCD had an 81.7% accuracy in identifying CAN [AUC = 0.817 (95% CI 0.692-0.942)] with an AMP_POCD ≤6 μV showing 90% sensitivity and 73% specificity. In a stepwise binary logistic regression analysis, the model (R² : 0.297; P < 0.001) retained the duration of type 1 diabetes [β: 1.131 (95% CI: 1.051-1.216); P = 0.001) and A_1c [β: 2.131 (95% CI: 1.060-4.283); P = 0.034) as significant predictors of CAN. The combination of AMP_POCD ≤6 μV + a type 1 diabetes duration of ≥8 years maximized the sensitivity, showing a diagnostic performance of 87% [AUC = 0.867 (95% CI 0.769-0.965)] with 90%, 76%, and 99%, sensitivity, specificity, and NPV, respectively. Adding A_1c ≥ 7% to this model maintained accuracy [AUC = 0.867 (95% CI: 0.788-0.963) and NPV (99%), while increasing specificity to 84%.

Conclusions

The combination of AMP_POCD with A_1c and the duration of type 1 diabetes mellitus showed a good performance for the detection of asymptomatic CAN, making POCD an easy and rapid test for its routine screening in the clinical setting.

SUBMITTER: Nattero-Chavez L

PROVIDER: S-EPMC9340859 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus.

Nattero-Chávez Lía L Luque-Ramírez Manuel M Quiñones-Silva Jhonatan J Montánez Laura L Fernández-Durán Elena E Dorado-Avendaño Beatriz B Escobar-Morreale Héctor F HF

Journal of diabetes investigation 20220510 8

<h4>Aims</h4>Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time-consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point-of-care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN.<h4>Methods</h4>Nerve amplitude (AMP<sub>POCD</sub> ) and conduction velocity (CV<sub>POCD</sub> ) were measured in a cross-sectional study including 198 asymptomatic patients w ...[more]

PMID: 35389567

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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.

Dataset Information

Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus.

Aims

Methods

Results

Conclusions

Publications

Point-of-care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus.

Similar Datasets

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