Diagnosis of diabetic polyneuropathy : does Neuropad lead to earlier detection?

Abstract

Overview: Diabetic Poyneuropathy (DPN) increases the risk of ulcerations and (lmput(ltions, which are the most frequent reasons for hospitalization of people with type 2 diabetes. Yet, the vast majority of amputations worldwide are preventable with timely diagnosis and routine foot care. Objective: The mm IS to identify the earliest way of diagnosing Diabetic Polyneuropathy in patients with diabetes mellitus type-2, by searching, reviewing and critically appraising all the accessible research that compares the diagnostic effectiveness of the visual indicator test-Neuropad® with established measures of somatic and autonomic diabetic neuropathy. PICO question: For patients with type II diabetes mellitus, does the Neuropad@ sudomotor function test lead to an earlier diagnosis of diabetic polyneuropathy when compared to routine diagnostic tests? PICO elements: Population (Type-2 diabetic patients), Intervention (Neuropad test), Comparison (routine diagnostic tests) and Outcome (earlier DPN diagnosis). Methods: A search for full text Neuropad® diagnostic studies, written in English and published within the last 1 0 years, was carried out on multiple search engines approach, like BioMedLib, PubMed, Advance Google Scholar Engine and the University of Malta databases via meta search. Twelve cross-sectional diagnostic studies and 2 systematic reviews fitting these inclusion criteria were retrieved. The studies were critically appraised according to their validity and relevance to the PICO question through the Critical Appraisal Skills Programme (CASP) tool for diagnostic case studies and the STARD checklist. The Neuropad test diagnostic efficacy values were compared systematically with those for other tests and Diabetic Polyneuropathy scores.

Results: In all the retrieved studies, Neuropad demonstrated equal to higher sensitivity and medium to low specificity when compared to other routine methods. Condnsions: Neuropad is an easy, inexpensive, visual test that can be readily used for Diabetic Polyneuropathy screening and self-check that enables timely initiation of preventive care. Implementation: The use of Neuropad test for the prompt detection of DPN in diabetic patients in Malta is recommended. This should be accompanied by an educational programme for health practitioners, especially nurses, in diabetic polyneuropathy diagnosis, management and prevention.