Journal of the peripheral nervous system : JPNS · 2026
Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk.
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Parikh Ethan, Al Mulla Abdulrhman, Lovblom Leif Erik, Budhram Dalton R, Orszag Andrej, Falappa Marcello, Gad Hoda, Bril Vera, Perkins Bruce A
Аннотация
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.
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.