Sural nerve activity, as non-invasively assessed using a point of care device, in individuals with and without type 2 diabetes

Physiology 2016 (Dublin, Ireland) (2016) Proc Physiol Soc 37, PCB208

Poster Communications: Sural nerve activity, as non-invasively assessed using a point of care device, in individuals with and without type 2 diabetes

J. Upadhyay1, K. M. Gooding1,2, F. Casanova1,2, D. Cox2, C. Ball2, S. Tesfaye3, A. C. Shore1,2

1. Diabetes and Vascular Medicine, University of Exeter Medical School, Exeter, United Kingdom. 2. NIHR Exeter Clinical Research Facility, Royal Devon and Exeter NHS Foundation Trust, Exeter, United Kingdom. 3. Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield, United Kingdom.

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Neuropathy, dysfunction of the nerves, is a known complication of diabetes. In clinical practice neuropathy is assessed by determining patients’ ability to detect pressure using monofilaments. However, monofilaments are an insensitive assessment for neuropathy. The quick, non-invasive assessment of sural nerve activity using the novel, point of care device, NC-stat DPN-check, has been proposed to detect early evidence of neuropathy. Little is known about the variability of sural nerve activity (conductance and amplitude) in healthy individuals and individuals with type 2 diabetes but no clinical evidence of neuropathy. This study aims to examine (1) intra-participant variability of sural nerve conductance velocity and amplitude in healthy individuals and (2) whether these parameters are altered by age or diabetes. Study 1: 5 healthy individuals were recruited (age range: 20-29yrs). Sural nerve conductance and amplitude was assessed using the DPN-Check device on 5 separate occasions for each participant. Coefficient of variation (CV) was calculated (standard deviation/mean x 100) to assess intra-participant reproducibility. Study 2: 3 groups were recruited: young healthy group (n = 19, age range: 20-36yrs, 8 males); older healthy group (n =20, age range= 48-75yrs, 10 M) and a type 2 diabetes (T2DM) group with no clinical evidence of neuropathy (n = 25, age range = 56-81yrs, 21 M). Each participant underwent the assessment of sural nerve conductance and amplitude by DPN-Check. Results: Study 1: Intra-participant CVs ranged from 4.0-6.9% and 26.0-39.4% for the assessment of sural nerve conductance and amplitude, respectively. Study 2: Sural nerve conductance was lower in individuals with T2DM compared to age-matched controls (T2DM group mean (SD): 43.5 (3.4); older healthy group: 47.1 (3.4), p = 0.003, Mann-Whitney U test), but was not altered by age (young healthy group: 58.4 (3.4)). Similarly, sural nerve amplitude was significantly reduced by diabetes (p = 0.012) but not age (T2DM group: 7.1 (5.7); older healthy group: 11.7 (7.3); young healthy group: 11.0 (3.7)). The non-invasive assessment of sural nerve conductance by DPN-Check demonstrates good intra-participant reproducibility in healthy individuals. The assessment of sural nerve amplitude was more variable in these individuals. Diabetes but not age per se was associated with a reduction in sural nerve conductance and amplitude prior to the development of clinical symptoms of neuropathy.



Where applicable, experiments conform with Society ethical requirements.

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