Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk

Abstract

Background

The American Diabetes Association recommends three rather than one physical examination test for diabetic peripheral neuropathy (DPN) screening, although supporting evidence for the more complex screening strategy remains limited.

Aims

We aimed to determine if a three-test strategy was superior to a single-test in sensitively identifying early stages of neuropathy risk.

Methods

Using longitudinal data from 170 adults without DPN, we compared the overall accuracy, represented by the area under the receiver operating characteristic curve (AUC), for the three-test versus one-test strategies. These were conducted for monofilament, pinprick, and vibration sensation compared to the Sum of Abnormal Tests (primary analysis) or a model-based probability from quantitative scores for each test in the prediction of nerve conduction study-defined incident DPN.

Results

Incident DPN occurred in 53 (31%) participants over a mean 4-year follow-up. Predictive AUC for both the Sum of Abnormal Tests or the model-based probability did not differ from the AUC for monofilament (0.66 vs. 0.71, p = 0.05 and 0.71 vs. 0.71, p = 0.79, respectively).

Interpretation

A complex three-test strategy did not outperform the best-performing single-test strategy, implying that practice guidelines that recommend simplified approaches to neuropathy screening are valid.