Monofilament testing and sudomotor function in a cohort of adults with type 1 diabetes
Diabetes Mellitus, Diabetic Neuropathies, Small Fiber Neuropathy.
Introduction: Diabetic neuropathy is one of the main complications found in individuals with diabetes mellitus. Loss of sensitivity and anidrosis are directly associated with the development of foot ulcers, a problem that generally precedes more than half of cases of non-traumatic amputations. Objective: The aim of this study was to evaluate different non-invasive diagnostic possibilities for preclinical signs and symptoms for DPN. Methods: This is a correlational, longitudinal study that analyzed the presence of sudomotor dysfunction in a cohort (type 1 diabetes mellitus) without clinical signs of DPN. Results: After a median period of 36 months (IQR 33 to 40.5 months), a significant reduction in electrochemical skin conductance (ESC) was observed, 73.6% of the participants did not present alteration in the sudomotor function in the first evaluation. In the second evaluation, there was a significant alteration: 28.9% of the patients had normal sudomotor function, 36.8% had moderate alteration and 13.2% had severe alteration. Regarding the evaluation with Semmes-Weinstem Monofilament, it was observed that 78.9% of the patients were classified as not presenting alteration and 21.1% as presenting mild alteration, in the first evaluation. After a median period of 36 months, in the second evaluation, it was observed that 55.2% of the patients had a normal monofilament evaluation and 23.7% had mild alterations. Conclusion: The ESC measurement proved to be an important predictor factor for NPD and that, associated with other non-invasive tests such as monofilament in smaller weights, can be an important tool in the screening of DPN.