CHEAP, FAST, OR ACCURATE: COMPARING THE PRACTICALITY OF SCREENING METHODS FOR DIABETIC PERIPHERAL NEUROPATHY

Abstract

Background: Diabetic peripheral neuropathy (DPN) affects at least half of people with diabetes and is a major risk factor for foot ulceration and amputation. Because nerve damage is least reversible late, a screening method's value depends on whether it can be delivered widely and early, not accuracy. Methods: This narrative review compared four DPN detection methods, nerve conduction studies, clinical sensory tests, plantar pressure analysis, and wearable gait sensing, across cost, setup, time, scalability, and accuracy. Results: Accuracy and scalability traded off. Nerve conduction studies are the accepted reference standard for large-fiber function but too specialist-dependent for population screening, while the cheapest test, the 10-gram monofilament, suits advanced disease better than early disease. Sensor-based methods report high accuracy from small, internally validated samples. Conclusion: No method is simultaneously cheap, fast, accurate, and sensitive to early disease. The unmet need is a scalable test externally validated for early detection.