Sympathetic skin response for early detection of type 2 diabetic peripheral neuropathy and nephropathy

Abstract

BackgroundDiabetic peripheral neuropathy (DPN) and diabetic nephropathy (DN) are common complications of type 2 diabetes mellitus (T2DM). Although nerve conduction studies (NCS) and sympathetic skin response (SSR) can detect DPN, the more sensitive method for early diagnosis remains unclear. Furthermore, whether DPN can be used as a predictor for diabetic nephropathy needs clarification.MethodsWe evaluated nerve conduction studies, sympathetic skin response, and the diabetic nephropathy indicator microalbuminuria (MAU) in 192 patients with type 2 diabetes mellitus and 50 healthy controls.ResultsPatients with type 2 diabetes mellitus showed a lower sensory nerve conduction velocity (SCV), sensory active nerve potential (SNAP), motor nerve conduction velocity (MCV), and compound motor action potential (CMAP) than the controls on NCS. Abnormal rates for nerve conduction studies and sympathetic skin response were 75.0% and 83.3%, respectively, in patients with type 2 diabetes mellitus. Interestingly, 54.2% of patients with normal nerve conduction studies had an abnormal sympathetic skin response. Moreover, we found a positive correlation between sympathetic skin response and microalbuminuria for the first time. The abnormal rate of microalbuminuria was 53.8%, lower than that of abnormal nerve conduction studies or sympathetic skin response patients.ConclusionSympathetic skin response is a more sensitive method than nerve conduction studies for the early diagnosis of diabetic peripheral neuropathy. Abnormal sympathetic skin response might serve as an indicator for early diabetic nephropathy. Additionally, diabetic peripheral neuropathy may occur earlier than diabetic nephropathy in the development of type 2 diabetes mellitus.

Advances in diagnostic methods for early‐stage diabetic polyneuropathy

“…The ability of the area under the curve to diagnose DPN was 0.663, and the apical cut‐off value was 56 ms. Sudomotor function was also useful for the early diagnosis of peripheral artery disease when combined with the ankle‐brachial index in patients with type 2 diabetes 13 . The sympathetic skin response identified using Synergy Mobile (Oxford, UK) showed that the latency of the sympathetic skin response was significantly higher in patients with type 2 diabetes than in healthy controls 14 . The sensitivity of the sympathetic skin response for detecting DPN was 83.3%.…”