Open AccessPoint‐of‐care sural nerve conduction could predict the presence of cardiovascular autonomic neuropathy in type 1 diabetes mellitus
Author(s) -
NatteroChávez Lía,
LuqueRamírez Manuel,
QuiñonesSilva Jhonatan,
Montánez Laura,
FernándezDurán Elena,
DoradoAvendaño Beatriz,
EscobarMorreale Héctor F.
Publication year - 2022
Publication title -
journal of diabetes investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.089
H-Index - 50
eISSN - 2040-1124
pISSN - 2040-1116
DOI - 10.1111/jdi.13803
Subject(s) - medicine , diabetes mellitus , logistic regression , type 2 diabetes mellitus , cardiology , asymptomatic , type 2 diabetes , diabetic neuropathy , nerve conduction velocity , area under the curve , endocrinology
Aims Assessment for cardiovascular autonomic neuropathy (CAN) in patients with type 1 diabetes mellitus remains time‐consuming in the clinical setting. We aimed to examine the diagnostic performance of a portable point‐of‐care diagnostic tool (POCD) for assessing sural nerve conduction during the screening of CAN. Methods Nerve amplitude (AMP POCD ) and conduction velocity (CV POCD ) were measured in a cross‐sectional study including 198 asymptomatic patients with type 1 diabetes. CAN was diagnosed by the Ewing score and power spectral heart rate [low‐frequency (LF) and high‐frequency (HF) activity]. Diagnostic accuracy was determined by ROC curves. Results CV POCD and AMP POCD showed positive correlations with LF and HF, and a negative correlation with age. Overall, AMP POCD had an 81.7% accuracy in identifying CAN [AUC = 0.817 (95% CI 0.692–0.942)] with an AMP POCD ≤6 μV showing 90% sensitivity and 73% specificity. In a stepwise binary logistic regression analysis, the model ( R 2 : 0.297; P < 0.001) retained the duration of type 1 diabetes [β: 1.131 (95% CI: 1.051–1.216); P = 0.001) and A 1c [β: 2.131 (95% CI: 1.060–4.283); P = 0.034) as significant predictors of CAN. The combination of AMP POCD ≤6 μV + a type 1 diabetes duration of ≥8 years maximized the sensitivity, showing a diagnostic performance of 87% [AUC = 0.867 (95% CI 0.769–0.965)] with 90%, 76%, and 99%, sensitivity, specificity, and NPV, respectively. Adding A 1c ≥ 7% to this model maintained accuracy [AUC = 0.867 (95% CI: 0.788–0.963) and NPV (99%), while increasing specificity to 84%. Conclusions The combination of AMP POCD with A 1c and the duration of type 1 diabetes mellitus showed a good performance for the detection of asymptomatic CAN, making POCD an easy and rapid test for its routine screening in the clinical setting.