Journal Article

Validity of a point-of-care nerve conduction device for polyneuropathy identification in older adults with diabetes: Results from the Canadian Study of Longevity in Type 1 Diabetes

Paul, Narinder, Bril, Vera, Keenan, Hillary A., Lovblom, Leif E., Brent, Michael H., Farooqi, Mohammed A., Ngo, Mylan, Orszag, Andrej, Scarr, Daniel, Cherney, David Z., Cardinez, Nancy, Perkins, Bruce A., Boulet, Genevieve, Lovshin, Julie A., Weisman, Alanna

2018

Overview

Point-of-care nerve conduction devices (POCD) have been studied in younger patients and may facilitate screening for polyneuropathy in non-specialized clinical settings. However, performance may be impaired with advanced age owing to age-related changes in nerve conduction. We aimed to evaluate the validity of a POCD as a proxy for standard nerve conduction studies (NCS) in older adults with type 1 diabetes (T1D). Sural nerve amplitude potential (AMP) and sural nerve conduction velocity (CV) was measured in 68 participants with ≥ 50 years T1D duration and 71 controls (from age/sex-matched subgroups) using POCD and NCS protocols. Agreement was determined by the Bland-Altman method, and validity was determined by receiver operating characteristic curves. T1D were 53% female, aged 66±8yr and had diabetes duration 54yr[52,58]. Controls were 56%(p = 0.69) female and aged 65±8yr(p = 0.36). Mean AMPPOCD and CVPOCD for the 139 participants was 7.4±5.8μV and 45.7±11.2m/s and mean AMPNCS and CVNCS was 7.2±6.1μV and 43.3±8.3m/s. Mean difference of AMPPOCD-AMPNCS was 0.3±3.8μV and was 2.3±8.5m/s for CVPOCD-CVNCS. A AMPPOCD of ≤6μV had 80% sensitivity and 80% specificity for identifying abnormal AMPNCS, while a CVPOCD of ≤44m/s had 81% sensitivity and 82% specificity to identify abnormal CVNCS. Abnormality in AMPPOCD or CVPOCD was associated with 87% sensitivity, while abnormality in both measures was associated with 97% specificity for polyneuropathy identification. The POCD has strong agreement and diagnostic accuracy for identification of polyneuropathy in a high-risk subgroup and thus may represent a sufficiently accurate and rapid test for routinely detecting those with electrophysiological dysfunction.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adults / Age / Aged / Biology and Life Sciences / Canada / Cohort Studies / Cross-Sectional Studies / Diabetes / Diabetes mellitus / Diabetes mellitus (insulin dependent) / Diabetes Mellitus, Type 1 - complications / Diabetic neuropathy / Diagnosis / Diagnostic systems / Elderly / Electrophysiology / Endocrinology / Epidemiology / Female / Health aspects / Health care networks / Health screening / Hospitals / Humans / Identification / Life assessment / Longevity / Male / Medicine / Medicine and Health Sciences / Metabolism / Methods / Middle Aged / Nephrology / Nerve conduction / Neural Conduction / Neurology / Neuromuscular diseases / Neurosciences / Older people / People and Places / Point-of-Care Systems / Polyneuropathies / Polyneuropathies - complications / Polyneuropathies - diagnosis / Polyneuropathy / Reproducibility of Results / Risk factors / Risk groups / ROC Curve / Science Policy / Sensitivity / Sensitivity and Specificity / Studies / Subgroups / Sural nerve / Type 1 diabetes / Validity