Usefulness of sudomotor function assessment in individuals with type-2 diabetes: A case–control study

Background

Early screening for type 2 diabetes is crucial to prevent complications such as peripheral neuropathy and their detrimental effects on quality of life and morbidity. Sudomotor function assessment may play a pivotal role in this regard.

Objective

The aim of this study was to evaluate the usefulness of sudomotor function assessment, derived from electrochemical skin conductance (ESC) measurement, for the diagnosis of diabetes in patients.

Methods

This case–control study was conducted at the University Hospital of Lomé in Togo and included 304 people with Diabetes and 475 control subjects. Sudomotor function was assessed in both groups using a single device (Sudoscan2, version SU2 01266). The ESC of the left and right hands and feet were measured in each subject and then averaged. A comprehensive examination was performed, and demographic, anthropometric, and clinical data were collected. Consent was obtained from all participants.

Results

The study found that people with Diabetes were significantly older, had a higher body mass index (BMI), and were more frequently male than the control group (median and [interquartile]: 57 [48–65] vs. 41 [30–52] years, p < 0.0001; 27 [24–31] vs. 25 [22–29] kg/m², p = 0.0042; 28% vs. 14%, p < 0.0001; respectively). Additionally, people with Diabetes had significantly lower averaged hands and feet ESC compared to the control group (hand ESC: 68 [58–75] vs. 57 [47–69] μS, p < 0.0001 and foot ESC: 74 [66–80] vs. 62 [45–71], p < 0.0001 respectively). Similar results were found in both men and women across all age groups. In multiple linear regression analysis, diabetes was found to be independently associated with lower ESC, even after adjusting for age, sex, and BMI. The area under the receiver operating characteristic curves for the diagnosis of diabetes were 0.73 (0.68–0.77) and 0.76 (0.71–0.80) for averaged hand and foot ESC, respectively. The identified thresholds of ESC for diabetes detection were 56 μS (sensitivity = 83%, specificity = 34%) and 66 μS (sensitivity = 86%, specificity = 45%) for hands and feet ESC, respectively.

Conclusion

Sudomotor function is reduced in people with Diabetes, regardless of age, sex, and BMI. The ESC measurement has good sensitivity and may be useful in screening patients at risk of diabetes, potentially leading to earlier diagnosis. However, further investigation is required to determine the relevance of systematic ESC measurement in terms of management and risk stratification for these patients.