Portable, easy to use device a promising new tool for cardiac autonomic neuropathy screening

NerveCheck Master could be a potential new screening tool for cardiac autonomic neuropathy, following promising results from a recent study.

The international study set out to evaluate the accuracy of NerveCheck Master (NCKM) against Michigan Neuropathy Screening Instrument (MNSI) examination to detect cardiac autonomic neuropathy (CAN) in people with type 1 and type 2 diabetes.

NCKM is a portable, quick and easy to use device that assesses vibration, warm, cold and heat pain perception thresholds.

The research team aimed to evaluate whether NCKM can serve as a reliable point-of-care diagnostic device, in light of the need for accessible and efficient tools for early diabetic neuropathy detection.

The key findings were that NCKM detects far more patients with diabetic polyneuropathy (DPN) than the physical component of MNSI. It also demonstrated that DPN as diagnosed using NCKM is associated with co-existing CAN, particularly in those with type 1 diabetes.

The results support that the presence of damage of small fibres at lower limbs, picked up using NCKM, is associated with a cardiovascular autonomic dysfunction.

The findings led the study authors to propose the potential role of NCKM in a screening step to identify people with diabetes who should be further assessed for CAN.

The bi-centre study involved 76 people with type 1 diabetes (median age of 35 years and duration of 13.5 years) and 65 people with type 2 diabetes (median age of 59 years and duration of 10 years) attending the Jean Verdier Hospital in Bondy, France or the Policlinico in Naples, Italy.

The research team reported the following results: “According to MNSI the prevalence of DPN was 26.3 per cent in type 1 diabetes and 35.4 per cent in type 2 diabetes. According to NCKM tests, the DPN prevalence was 61.8 per cent and 70.8 per cent, respectively.

“The prevalence of CAN was 22.4 per cent and 41.4 per cent among people with type 1 diabetes and type 2 diabetes, respectively. Considering DPN as defined by NCKM, the association with CAN was significant in the whole population (p=0.013) and in type 1 diabetes, not in type 2 diabetes. Among people with type 1 diabetes the prevalence of CAN was markedly higher in those with DPN than in those without (31.9 per cent vs 6.9 per cent, p=0.011).

“A ROC curve analysis was performed to evaluate the performance of the total NCKM score (defined upon the four tests) for the detection of patients with CAN. The ROC-AUC was 0.62 for the total population, 0.67 for people with type 1 diabetes and 0.55 for type 2 diabetes subjects. An NCKM score of two abnormal tests was identified as the best cut-off level, which offered rather good sensitivity and negative predictive value, particularly among people with type 1 diabetes (88.2 per cent and 93.1 per cent, respectively), while the performance was lesser in people with type 2 diabetes (75 per cent and 66.7 per cent, respectively).”

Read more in the Journal of Diabetes and its Complications.