TY - JOUR
TI - A simple plaster for screening for diabetic neuropathy: A diagnostic
test accuracy systematic review and meta-analysis
AU - Tsapas, Apostolos
AU - Liakos, Aris
AU - Paschos, Paschalis and
AU - Karagiannis, Thomas
AU - Bekiari, Eleni
AU - Tentolouris, Nikolaos and
AU - Boura, Panagiota
JO - Metabolism: Clinical and Experimental
PY - 2014
VL - 63
TODO - 4
SP - 584-592
PB - W B SAUNDERS CO-ELSEVIER INC
SN - 0026-0495
TODO - 10.1016/j.metabol.2013.11.019
TODO - Diabetic neuropathy; Diabetic foot; Neuropad; Diagnostic accuracy;
Meta-analysis
TODO - Objective. Neuropad is an adhesive indicator test applied at the plantar
surface of the foot that detects sweating through color change. We
examined the diagnostic accuracy of this simple plaster as triage test
for screening for clinically relevant diabetic sensorimotor
polyneuropathy in adult outpatients with type 1 or type 2 diabetes.
Materials/Methods. Systematic review and meta-analysis of diagnostic
accuracy studies. We searched Medline, Embase, Cochrane Library, Biosis
Previews, Web of Science, Scopus and gray literature without date or
language restrictions. We pooled estimates of sensitivity and
specificity, and fitted hierarchical models to produce summary receiver
operating characteristic curves. We assessed methodological quality of
included studies utilizing the Quality Assessment of Diagnostic Accuracy
Studies 2 tool.
Results. Eighteen studies with 3470 participants met the inclusion
criteria. Average sensitivity and specificity were 86% (95% CI 79 to
91) and 65% (95% CI 51 to 76) respectively. Likelihood ratios (LRs)
were LR+ = 2.44 and LR- = 0.22. Subgroup analyses per reference standard
utilized provided similar estimates. Most studies were at risk of bias
for patient selection and use of index or reference test, and had
concerns regarding applicability due to patient selection.
Conclusion. The adhesive indicator test has reasonable sensitivity and
could be used for triage of diabetic neuropathy to rule out foot at
risk. Patients who tested positive should be referred to specialized
care to establish a definite diagnosis. There is insufficient evidence
for effectiveness on patient-important outcomes and cost-effectiveness
of implementation in the diagnostic pathway compared with the standard
clinical examination. (C) 2014 Elsevier Inc. All rights reserved.
ER -