Combined Point-of-Care Devices, DPN-Check and Sudoscan, Diagnose Early DPN and Predict Diabetic Foot Ulceration

Introduction and Objective: Diabetic peripheral neuropathy (DPN) is the strongest risk factor for diabetic foot ulceration (DFU). Current screening methods (e.g. 10g monofilament [10g-MFT]) are crude and diagnose DPN late when the condition is already well established. Point-of-care devices (POCDs), DPN-Check, a hand-held device that measures nerve conduction/amplitude and SUDOSCAN that measures sudomotor function, diagnose DPN early. However, their abilities to predict incident DFU is unknown. Methods: 229 consecutive participants with diabetes were followed up for 9 years and underwent detailed assessments including: the Toronto Clinical Neuropathy Score (TCNS), 10g-MFT, and POCD. Risk of incident DFU was analysed using odds-ratios for participants with abnormal baseline TCNS, 10gMFT and combined POCDs tests who developed DFU at follow-up. Results: At baseline, the prevalence of DPN diagnosed was 14.4%, 27% and 66.8% for MFT(n=33), TCNS(n=62) and POCD(n=153) respectively. 100 participants attended the 9 year follow-up however 59 participants died. Those who attended follow up visits were significantly younger [58.0(11.1)vs59.1(17.8) years;(p<0.001(95%CI:4.1:11.4)], had fewer co-morbidities [2.7vs3.2; P<0.001] and lower Q-risk score (21.4(12.9)vs24.5(14.4); p<0.001). Thirty-five (15.3%) participants developed DFU. Participants with abnormal POCDs at baseline demonstrated a 4.4-fold increased risk [(n=31),95%CI:1.5:12.9, p<0.004)] of developing DFU compared to those with normal POCDs at baseline. There was also an increased risk of incident DFU with DPN diagnosed using TCNS [(n=17), OR 2.9(95%CI:1.4:6.1, p=0.004)] and 10g-MFT [(n=13), OR 4.5(95%CI:1.9:10.4, p<0.001)]. Conclusion: We have demonstrated that abnormal POCD tests predict greater number of incident DFUs. These results advocate the use of POCDs to predict DFUs at an early stage, when preventative measures can be implemented. Disclosure: M. Goonoo: None. D. Selvarajah: None. G.P. Sloan: Speaker's Bureau; Eli Lilly and Company, Procter & Gamble. S. Tesfaye: Advisory Panel; AstraZeneca, Bayer Pharmaceuticals, Inc. Speaker's Bureau; Berlin-Chemie AG. Advisory Panel; Grünenthal. Speaker's Bureau; Metronics, Novo Nordisk. Advisory Panel; Procter & Gamble. Speaker's Bureau; Viatris Inc. Advisory Panel; Nevro Corp. Funding: Proctor and Gamble (STH22196)