NerveCheck master to screen patients with type 1 or type 2 diabetes for peripheral and cardiac autonomic neuropathy

Aim: NerveCheck Master (NCKM) is a portable device designed to assess vibration, warm, cold and heat pain perception thresholds. NCKM was shown to offer good diagnostic accuracy for diabetic peripheral neuropathy (DPN). Cardiac autonomic neuropathy (CAN) remains underdiagnosed. We assessed the role of NCKM against Michigan Neuropathy Screening Instrument (MNSI) to screen patients with diabetes for both DPN and CAN. Methods: DPN was assessed using the 4 NCKM tests and MNSI, and CAN using standard tests, in 76 patients with type 1 (T1DM) and 65 with type 2 diabetes mellitus (T2DM). Results: Among patients with T1DM and T2DM, DPN prevalence was 26.3 % and 35.4 %, respectively, according to MNSI score (≥2.5), and 61.8 % and 70.8 % according to NCKM (≥2 abnormal tests), and CAN prevalence was 22.4 % and 41.4 %, respectively. Among patients with T1DM, CAN prevalence was markedly higher in those with DPN according to NCKM than in those without (31.9 % vs 6.9 %, p = 0.011), with a far lesser difference among patients with T2DM. The cut-off of two abnormal tests offers good sensitivity and negative predictive value for the detection of patients with CAN, particularly among patients with T1DM (88.2 % and 93.1 %, respectively). Conclusion: NCKM detects more patients with DPN and its positivity is associated with a higher likelihood of CAN. Using NCKM appears an attractive approach to identify patients to screen for CAN and to improve the yield of CAN tests.