Sudomotor Dysfunction in Fibrocalculous Pancreatic Diabetes: Clinical Insights From Electrochemical Skin Conductance Testing.

BACKGROUND

Fibrocalculous pancreatic diabetes is a unique form of diabetes prevalent in tropical regions, characterized by chronic calcific pancreatitis and a high burden of diabetic complications. Sudomotor dysfunction remains underexplored in this population.

AIM: To determine the prevalence and clinical determinants of sudomotor dysfunction in individuals with fibrocalculous pancreatic diabetes.

METHODS

In this cross-sectional study, 90 patients with fibrocalculous pancreatic diabetes were evaluated at a tertiary care endocrinology centre. Sudomotor function was assessed using electrochemical skin conductance. Large fiber neuropathy was evaluated using vibration perception threshold testing and nerve conduction studies. Agreement between modalities was assessed using Cohen's kappa, and logistic regression was used to identify the predictors of sudomotor dysfunction.

RESULTS

Sudomotor dysfunction was present in 43.3% of patients, compared with abnormalities in vibration perception threshold (17.8%) and nerve conduction studies (21.1%). Agreement between electrochemical skin conductance and large fiber measures was fair to moderate (κ=0.39-0.47), while the vibration perception threshold and nerve conduction studies showed substantial concordance (κ=0.61). In multivariable analysis, increasing age (odds ratio: 1.08; 95% confidence interval: 1.00-1.16) and longer duration of diabetes (odds ratio: 1.26; 95% confidence interval: 1.07-1.49) were independently associated with sudomotor dysfunction.

CONCLUSIONS

Sudomotor dysfunction assessed by electrochemical skin conductance was common in fibrocalculous pancreatic diabetes and detected more frequently than abnormalities on vibration perception threshold or nerve conduction studies. Electrochemical skin conductance may serve as a practical adjunctive tool for evaluating sudomotor dysfunction in this population, although longitudinal studies are needed to clarify its clinical significance.