Useful Application of the Neuropad Test for Assessment of Diabetic Polyneuropathy

OBJECTIVE: Examination of sudomotor function is now recommended to assess peripheral autonomic dysfunction. The aim of this study was to evaluate the clinical usefulness of Neuropad, a simple visual indicator test, for assessment of diabetic polyneuropathy (DPN). METHODS: This study examined 87 diabetic patients with a mean age of 61.1±8.8 years, a mean diabetes duration of 13.0±7.5 years and a mean HbA1c of 8.8±1.7%. Diagnosis of DPN was based on clinical examinations using modified Toronto Clinical Neuropathy Score (mTCNS). The patients also underwent 4-g monofilament test and heart rate variability by coefficient of variation of R-R intervals (CV(R-R)) was determined with the patients at rest. The Neuropad test was applied on the plantar aspect of the great toe and removed after 10 minutes to evaluate the color change as normal (blue to completely pink), patchy (patches of blue and pink) and abnormal (remained blue). RESULTS: Twenty-eight patients showed a normal, 45 patchy and 14 abnormal response to the Neuropad test. Patients with an abnormal response had significantly longer diabetes duration than those with a normal or a patchy response, but HbA1c levels were similar among the three groups. The C(R-R) at rest was significantly lower in patients with an abnormal response than those of normal and patchy response, respectively. Abnormal responders showed significantly higher mTCNS and lower monofilament results as well as higher prevalence of orthostatic hypotension, retinopathy or nephropathy than normal responders. CONCLUSION: The Neuropad test is a useful screening test for detecting DPN.