Assessment of small fiber neuropathy to predict future risk of type 2 diabetes

Objective: Sudomotor dysfunction due to small fiber neuropathy can be observed very early in pre-diabetes. The aim of this study was to assess the predictive power of EZSCAN, a non invasive, quick and simple measurement of sudomotor function to identify glucose impairment. Research design and methods: The study was performed in 76 German subjects at risk of diabetes. Glucose metabolism was assessed by using, oral glucose tolerance test (OGTT) at baseline and after 2 year follow-up. Sudomotor function was evaluated by measuring hand and foot electrochemical sweat conductances to calculate a risk score. Results: At baseline, 38 patients had normal glucose tolerance (NGT), 34 had pre-diabetes (impaired fasting glucose, IFG and/or impaired glucose tolerance, IGT) and 4 had newly diagnosed type 2 diabetes. The AUC values for FPG, 2 h-OGTT glucose, 1 h-OGTT glucose, HbA(1c) and EZSCAN score to predict pre-diabetes were 0.50, 0.65, 0.64, 0.72 and 0.76, respectively. Subjects having a moderate or high EZSCAN score (>50) at baseline had a substantially increased risk for having IFG and/or IGT at follow-up visit presented by an odds ratio of 12.0 [1.4-100.5], the OR for having 1 h-OGTT >= 8.6 mmol/L at follow-up was 9.8 [1.0-92.8] and for having HbA(1c) >= 5.7% was 15.7 [1.9-131.5] compared to subjects with low EZSCAN risk. Conclusions: This preliminary study, which must be confirmed in a larger population, shows that EZSCAN risk score is associated with diabetes progression which have implications for prevention and disease management. (C) 2013 Published by Elsevier Ltd on behalf of Primary Care Diabetes Europe.