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A simple new non‐invasive sweat indicator test for the diagnosis of diabetic neuropathy
Authors:N Papanas  A J M Boulton  R A Malik  C Manes  O Schnell  V Spallone  N Tentolouris  S Tesfaye  P Valensi  D Ziegler  P Kempler
Institution:1. Outpatient Clinic of the Diabetic Foot, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece;2. University of Manchester and Manchester Diabetes Centre, Manchester, UK;3. Division of Endocrinology, Diabetes and Metabolism, University of Miami, Miller School of Medicine, Miami, USA;4. Diabetes Centre, ‘Papageorgiou’ Hospital, Thessaloniki, Greece;5. Forschergruppe Diabetes e.V. at the Helmholtz Centre Munich, Munich, Germany;6. Endocrinology, Department of Internal Medicine, Tor Vergata University, Rome, Italy;7. Diabetes Centre and 1st Propaedeutic Department of Internal Medicine, University of Athens, Athens, Greece;8. Diabetes Research Unit, Sheffield Teaching Hospitals, University of Sheffield, Sheffield, UK;9. Department of Endocrinology, Diabetology and Nutrition, Jean Verdier Hospital, AP‐HP, Paris Nord University, CRNH‐IdF, Bondy, France;10. Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research and Department of Metabolic Diseases, University Hospital, Düsseldorf, Germany;11. First Department of Medicine, Semmelweis University, Budapest, Hungary
Abstract:A simple non‐invasive indicator test (Neuropad®) has been developed for the assessment of sweating and, hence, cholinergic innervation in the diabetic foot. The present review summarizes current knowledge on this diagnostic test. The diagnostic ability of this test is based on a colour change from blue to pink at 10 min, with excellent reproducibility, which lends itself to patient self‐examination. It has a high sensitivity (65.1–100%) and negative predictive value (63–100%), with moderate specificity (32–78.5%) and positive predictive value (23.3–93.2%) for the diagnosis of diabetic peripheral neuropathy. It also has moderate to high sensitivity (59.1–89%) and negative predictive value (64.7–91%), but low to moderate specificity (27–78%) and positive predictive value (24–48.6%) for the diagnosis of diabetic cardiac autonomic neuropathy. There are some data to suggest that Neuropad can detect early diabetic neuropathy, but this needs further evaluation. It remains to be established whether this test can predict foot ulceration and amputation, thereby contributing to the identification of high‐risk patients. Diabet. Med. 30, 525–534 (2013)
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