[Neuropad test in evaluation of diabetic foot]

Diabetic neuropathy (DN) is the main cause of foot ulceration. One of the earliest modifications is the loss of normal sudomotor function, a sign of autonomic neuropathy. The aim of this study is to evaluate sudomotor dysfunction using a new tool (Neuropad) in diabetic patients with foot ulceration.

We included 58 diabetic patients with foot ulceration admitted in 2010 in the Clinical Center for Diabetes, Nutrition and Metabolic Diseases. We collected data regarding age, gender, type and duration of diabetes, glycated hemoglobin (HbAlc), history of amputations and duration of hospital admission. Peripheral neuropathy was evaluated through the Neuropathy Disability Score (NDS) and autonomic neuropathy was tested through Neuropad.

95% of patients had NDS > or = 6, among which 76% had also positive Neuropad test. Patients with both peripheral and autonomic neuropathy had longer duration of diabetes (p = 0.027) but similar HbA1c as patients with only peripheral neuropathy (p = 0.09). The former also had longer duration of current admission (p = 0.022) and a higher percentage of these patients had history of amputations (p = 0.041).

Neuropad is a reliable, easy to use test for the diagnosis of autonomic neuropathy, which puts patients at greater risk for foot ulceration and amputation.