Automated Quantification of Neuropad Improves Its Diagnostic Ability in Patients with Diabetic Neuropathy

Georgos Ponirakis, Hassan Fadavi, Ioannis N Petropoulos, Shazli Azmi, Maryam Ferdousi, Mohammad Dabbah, Ahmad Kheyami, Uazman Alam, Omar Asghar, Andrew Marshall, Mitra Tavakoli, Ahmed Al-Ahmar, Saad Javed, Maria Jeziorska, Rayaz A Malik

Research output: Contribution to journalArticlepeer-review


Neuropad is currently a categorical visual screening test that identifies diabetic patients at risk of foot ulceration. The diagnostic performance of Neuropad was compared between the categorical and continuous (image-analysis (Sudometrics)) outputs to diagnose diabetic peripheral neuropathy (DPN). 110 subjects with type 1 and 2 diabetes underwent assessment with Neuropad, Neuropathy Disability Score (NDS), peroneal motor nerve conduction velocity (PMNCV), sural nerve action potential (SNAP), Deep Breathing-Heart Rate Variability (DB-HRV), intraepidermal nerve fibre density (IENFD), and corneal confocal microscopy (CCM). 46/110 patients had DPN according to the Toronto consensus. The continuous output displayed high sensitivity and specificity for DB-HRV (91%, 83%), CNFD (88%, 78%), and SNAP (88%, 83%), whereas the categorical output showed high sensitivity but low specificity. The optimal cut-off points were 90% for the detection of autonomic dysfunction (DB-HRV) and 80% for small fibre neuropathy (CNFD). The diagnostic efficacy of the continuous Neuropad output for abnormal DB-HRV (AUC: 91%, P = 0.0003) and CNFD (AUC: 82%, P = 0.01) was better than for PMNCV (AUC: 60%). The categorical output showed no significant difference in diagnostic efficacy for these same measures. An image analysis algorithm generating a continuous output (Sudometrics) improved the diagnostic ability of Neuropad, particularly in detecting autonomic and small fibre neuropathy.

Original languageEnglish
Article number847854
Number of pages7
JournalJournal of Diabetes Research
Publication statusPublished - 2015


  • Action Potentials
  • Autonomic Nervous System
  • Diabetes Mellitus, Type 1
  • Diabetes Mellitus, Type 2
  • Diabetic Neuropathies
  • Female
  • Foot Ulcer
  • Humans
  • Male
  • Neural Conduction
  • Physical Examination
  • Sensitivity and Specificity
  • Sural Nerve
  • Journal Article
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't


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