Evaluation of the electrochemical skin conduction with the SUDOSCAN+ device in the diagnosis of diabetic neuropathy in patients with type 1 diabetes

Introduction. Dysfunction of the sweat glands is an early clinical manifestation of diabetic neuropathy. SUDOSCAN+ is a device used to noninvasively assess the function of the sweat glands on the basis of the electrochemical reaction of chlorine ions secreted in sweat due to low voltage current. The aim of the study was to evaluate the electrochemical skin conductance with the device SUDOSCAN+ in the diagnosis of neuropathy in patients with type 1 diabetes. Material and methods. The study included 203 patients with type 1 diabetes (95 women and 108 men) aged 39 years (IQR: 31-50), with disease duration of 22 years (IQR: 17-30) hospitalized in the Department of Internal Medicine and Diabetology, Poznan University of Medical Sciences, between years 2013-2014. The study group was subdivided into two groups depending on the presence of peripheral neuropathy identified by standard methods. In the study group we performed analysis of electrochemical skin conduction (ESC) measured with SUDOSCAN+ on the hands and feet with estimation of Risk of Autonomic Neuropathy. We also evaluated the accumulation of advanced glycation end products in the skin on the basis of the autofluo-rescence skin ratio (AGE Reader device). Results. We diagnosed peripheral neuropathy in 45.3% of patients. Patients with peripheral neuropathy, compared to those without clinical neuropathy, had lower Feet ESC [70.5 (IQR: 51.5-83) vs. 83 mu S (IQR: 78-87), p < 0.001], Hands ESC [58.5 (IQR: 47.5-71.5) vs. 70 mu S (IQR: 61-78), p < 0.001] and a higher Risk of Autonomic Neuropathy [24.5 (IQR: 13-35) vs. 11% (IQR: 1-20), p < 0.001]. We found a negative correlation between the result of the Feet ESC and patients age (Rs = -0.40, p < 0.001), duration of diabetes (Rs = -0.32, p < 0.001), skin autofluo-rescence (Rs = p < 0.001) and positive correlation with the eGFR (Rs = 0.32, p < 0.001). Conclusions. Electrochemical skin conductance is reduced in patients with type 1 diabetes and diabetic neuropathy. Sudomotor dysfunction is related to longer duration of diabetes, chronic metabolic uncontrolled diabetes, and worse renal function.