2716-LB: Reproducibility and Diagnostic Validity of ACT, a Simple Self-Administered Screening Tool for Diabetic Peripheral Neuropathy

Introduction and Objective: Up to 80% of patients with diabetic peripheral neuropathy (DPN) may go undiagnosed. Screening is rarely undertaken in busy clinics due to the complexity of many current screening questionnaires. An international panel of practitioners developed a quick, practical tool (A Simple sCreening Tool-ACT) which consists of a patient self-administered and self-scored questionnaire and a simplified clinician sensory examination. We have evaluated the reproducibility and diagnostic validity of ACT. Methods: 126 adults with type 1 or type 2 diabetes were consecutively recruited from an endocrinology clinic. Participants underwent assessment with ACT (Questionnaire-score 0-14, sensory exam-score 2-6) and the Michigan Neuropathy Screening Instrument (MNSI) at baseline and after 14 days. Reproducibility was assessed using intraclass correlation coefficients (ICC), and neuropathy classification by Cohen’s kappa (κ). Overall diagnostic accuracy for DPN was evaluated by the Area Under the receiver operating characteristic curve (AUC) (MNSIq >4 + MNSIe ≥2.5). Results: The study included 126 participants with mean age-52.5 ± 12.4 years, 62.7% male, median HbA1c-7.8% [6.7-9.3], median duration of diabetes-14 years [5-20]. DPN was identified in 19/126 participants (15.1%) based on the MNSI, and 15/126 participants (11.9%) based on ACT. The ACT quantitative score demonstrated good 14-day reproducibility (ICC=0.85) which was comparable to MNSI (ICC=0.85). ACT neuropathy (ACTq >4 + ACTe >3) classification (present vs. absent) showed good repeatability (κ=0.83), whilst MNSI showed moderate repeatability (κ=0.64). Furthermore, the overall diagnostic validity for ACT was excellent-AUC=0.902. Conclusion: ACT demonstrated good reproducibility and excellent diagnostic validity compared to MNSI. The self-administration of ACT together with its brevity are key to enabling widespread implementation in busy clinics to increase screening and address underdiagnosis of DPN. Disclosure H. Gad: Consultant; Current; Procter & Gamble. E. Elgassim: None. S. Bennabhaktula: None. A.K. Baraka: None. K. Baagar: None. A. Orszag: None. L. Lovblom: None. B. Perkins: Advisory Panel; Current; Abbott Diabetes. Other - CME event speaker; Ended; Bayer AG, Dexcom, Inc. Advisory Panel; Ended; Insulet Corporation. Advisory Panel; Current; Novo Nordisk A/S. Other - Advisory and CME event speaker; Current; Sanofi. Research Support; Current; Vertex Pharmaceuticals Incorporated, Zucara Therapeutics. R.A. Malik: None.