1
|
Nkonge KM, Nkonge DK, Nkonge TN. Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetol Metab Syndr 2023; 15:55. [PMID: 36945043 PMCID: PMC10031885 DOI: 10.1186/s13098-023-01032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/15/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed. MAIN BODY Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings. CONCLUSIONS Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.
Collapse
|
2
|
Chicharro-Luna E, Ortega-Avila AB, Requena-Martínez A, Gijon Nogueron G. Concordance between sudomotor disorder and the clinical diagnosis of diabetic peripheral neuropathy, according to various clinical guidelines. Prim Care Diabetes 2021; 15:853-858. [PMID: 34108112 DOI: 10.1016/j.pcd.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/25/2021] [Accepted: 05/30/2021] [Indexed: 11/26/2022]
Abstract
AIM To assess the concordance between variations in Neuropad® results and the those in different diagnostic criteria of Diabetic Peripheral Neuropathy, according to various clinical guidelines. METHODS A descriptive observational study was conducted of 111 patients with a confirmed diagnosis of diabetes mellitus. The criteria for inclusion in the study were that patients should be aged 18 years or more and have at least 10 years' history of diabetes mellitus. RESULTS 73 (65.8%) were male and 38 (34.2%) were female. Their mean age was 57.92 ± 13.24 years (95% CI 55.45-60.38). Healthy Neuropad® findings were obtained for 35 right feet (31.5%) and 31 left feet (27.9%). CONCLUSION Neuropad® is an effective instrument for detecting macro and microvascular complications such as early-stage neuropathy, although its use should always be accompanied by a clinical examination of the foot.
Collapse
Affiliation(s)
- Esther Chicharro-Luna
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, Alicante, Spain
| | - Ana Belen Ortega-Avila
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain.
| | - Aranza Requena-Martínez
- Department of Behavioural Sciences and Health, University of Miguel Hernandez, Alicante, Spain
| | - Gabriel Gijon Nogueron
- Department of Nursing, University of Malaga, Spain; Biomedical Research Institute (IBIMA), Malaga, Spain
| |
Collapse
|
3
|
Rodríguez-Sánchez B, Peña-Longobardo LM, Sinclair AJ. Cost-effectiveness analysis of the Neuropad device as a screening tool for early diabetic peripheral neuropathy. Eur J Health Econ 2020; 21:335-349. [PMID: 31720872 DOI: 10.1007/s10198-019-01134-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 10/30/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To carry out a cost-effectiveness analysis of the use of Neuropad as a screening test for diabetic neuropathy together with the standard care tool, the 10-g monofilament, in people with diabetes. RESEARCH DESIGN AND METHODS A cost-effectiveness analysis using a Markov model was developed to assess the impact on costs and outcomes of using Neuropad as a test for diabetic neuropathy (1) as a complement to the standard test, the 10-g monofilament (Neuropad + monofilament vs. monofilament); and (2) as a substitute for the monofilament (Neuropad vs. monofilament); from the healthcare provider perspective. The time horizon was 3 years. Data on costs and health gains were extracted from the literature. The incremental cost-utility ratio was calculated. Deterministic and probabilistic sensitivity analyses were also performed. RESULTS Compared with standard care, Neuropad, in combination with the 10-g monofilament tool, is the dominant strategy as it leads to higher health gains and lower costs. In practice, compared with using the monofilament alone, performing both tests would lead to a savings of £1049.26 per patient and 0.044 QALY gain. Results were found to be consistent across the sensitivity analyses. CONCLUSIONS Using both screening tools (Neuropad + monofilament) is a cost-effective strategy and the dominant alternative, when compared against using the 10-g monofilament alone. The results would be of special relevance in the early detection of diabetic peripheral neuropathy and to ensure the efficient allocation of resources and, thus, the sustainability of healthcare systems.
Collapse
Affiliation(s)
- B Rodríguez-Sánchez
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Calle San Pedro Mártir 7, 45002, Toledo, Spain.
| | - L M Peña-Longobardo
- Faculty of Law and Social Sciences, University of Castilla-La Mancha, Calle San Pedro Mártir 7, 45002, Toledo, Spain
| | - A J Sinclair
- Foundation for Diabetes Research in Older People, Diabetes Frail Ltd, University of Aston, Birmingham, UK
| |
Collapse
|
4
|
Zouari HG, Ng Wing Tin S, Wahab A, Damy T, Lefaucheur JP. Assessment of autonomic innervation of the foot in familial amyloid polyneuropathy. Eur J Neurol 2018; 26:94-e10. [PMID: 30102818 DOI: 10.1111/ene.13774] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 08/09/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Distal involvement of autonomic nerve fibers is critical in familial amyloid polyneuropathy (FAP) due to transthyretin (TTR) mutation. This study compares different methods for assessing autonomic foot innervation in TTR-FAP patients. METHODS Three groups of seven TTR-FAP patients were included, according to disease severity: clinically asymptomatic, moderate or advanced neuropathy. The autonomic investigation included the eutectic mixture of local anesthetics test and laser Doppler flowmetry for vasomotor aspects and the Sudoscan® (measuring electrochemical skin conductance) and Neuropad® test for sudomotor aspects. Somatic innervation was assessed by performing nerve conduction studies, quantitative sensory testing [including vibration, cold and warm detection threshold (WDT) measurements] and laser evoked potentials. RESULTS The results of all neurophysiological tests varied according to TTR-FAP severity (P ≤ 0.01, Kruskal-Wallis test), except for the eutectic mixture of local anesthetics test and laser Doppler flowmetry variables. In addition, the sudomotor tests (Sudoscan or Neuropad) or WDT measurement provided early markers of neuropathy in two of the seven asymptomatic carriers. Finally, all neurophysiological results correlated with the Neuropathy Impairment Score (r values between -0.88 and -0.66, P < 0.005, Spearman test), except the cold detection threshold. CONCLUSIONS The Neuropad test could be used to detect TTR-FAP onset, but confirmation requires electrochemical skin conductance and WDT measurement. The Sudoscan technique, but not the Neuropad test (at least assessed at a fixed time point), could be valuable to follow the progression of the neuropathy. Follow-up investigation should also include large-fiber investigation (e.g. nerve conduction studies and vibration detection threshold). Conversely, reliable tests for assessing vasomotor disturbances in limb extremities of TTR-FAP patients are still awaited.
Collapse
Affiliation(s)
- H G Zouari
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Service d'Explorations Fonctionnelles, CHU Habib Bourguiba, Sfax, Tunisie
| | - S Ng Wing Tin
- Service de Physiologie, Explorations Fonctionnelles et Médecine du Sport, Hôpital Avicenne, Assistance Publique - Hôpitaux de Paris, Bobigny, France.,EA 2363, UFR SMBH, Université Paris 13, Bobigny, France
| | - A Wahab
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France
| | - T Damy
- Service de Cardiologie, Unité d'Insuffisance, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,GRC Institut de Recherche sur l'Amylose, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Réseau Amylose Henri-Mondor, Hôpital Henri Mondor, Créteil, France
| | - J-P Lefaucheur
- EA 4391, Faculté de Médecine, Université Paris Est Créteil, Créteil, France.,Service de Physiologie, Explorations Fonctionnelles, Unité de Neurophysiologie Clinique, Hôpital Henri Mondor, Assistance Publique - Hôpitaux de Paris, Créteil, France.,Réseau Amylose Henri-Mondor, Hôpital Henri Mondor, Créteil, France
| |
Collapse
|
5
|
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; 63:584-92. [PMID: 24405753 DOI: 10.1016/j.metabol.2013.11.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 11/22/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Neuropad is an adhesive indicator test applied at the plantar surface of the foot that detects sweating through color change. We examined the diagnostic accuracy of this simple plaster as triage test for screening for clinically relevant diabetic sensorimotor polyneuropathy in adult outpatients with type 1 or type 2 diabetes. MATERIALS/METHODS Systematic review and meta-analysis of diagnostic accuracy studies. We searched Medline, Embase, Cochrane Library, Biosis Previews, Web of Science, Scopus and gray literature without date or language restrictions. We pooled estimates of sensitivity and specificity, and fitted hierarchical models to produce summary receiver operating characteristic curves. We assessed methodological quality of included studies utilizing the Quality Assessment of Diagnostic Accuracy Studies 2 tool. RESULTS Eighteen studies with 3470 participants met the inclusion criteria. Average sensitivity and specificity were 86% (95% CI 79 to 91) and 65% (95% CI 51 to 76) respectively. Likelihood ratios (LRs) were LR+=2.44 and LR-=0.22. Subgroup analyses per reference standard utilized provided similar estimates. Most studies were at risk of bias for patient selection and use of index or reference test, and had concerns regarding applicability due to patient selection. CONCLUSION The adhesive indicator test has reasonable sensitivity and could be used for triage of diabetic neuropathy to rule out foot at risk. Patients who tested positive should be referred to specialized care to establish a definite diagnosis. There is insufficient evidence for effectiveness on patient-important outcomes and cost-effectiveness of implementation in the diagnostic pathway compared with the standard clinical examination.
Collapse
Affiliation(s)
- Apostolos Tsapas
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece; Harris Manchester College, University of Oxford, Oxford, OX1 3TD, United Kingdom.
| | - Aris Liakos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Paschalis Paschos
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Eleni Bekiari
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| | - Nikolaos Tentolouris
- First Department of Propedeutic and Internal Medicine, University of Athens School of Medicine, 17 Ag. Thoma Street, 11527 Athens, Greece
| | - Panagiota Boura
- Second Medical Department, Aristotle University Thessaloniki, 49 Konstantinoupoleos Street, 54642 Thessaloniki, Greece
| |
Collapse
|