Evaluation of the Degree of Agreement of Four Methods for Diagnosing Diabetic Autonomic Neuropathy

Yu Peng; Ying-Shan Liu; Min-Yi Wu; Chu-Na Chen; Chu-Qiao Li; An-Qi Jiang; Chong-Xin Li; Yao Wang; Ge Tian; Su-Yue Pan; Ling-Ling Xu

doi:10.3389/fneur.2021.637099

Evaluation of the Degree of Agreement of Four Methods for Diagnosing Diabetic Autonomic Neuropathy

Front Neurol. 2021 May 25:12:637099. doi: 10.3389/fneur.2021.637099. eCollection 2021.

Authors

Yu Peng¹, Ying-Shan Liu^{2

3}, Min-Yi Wu¹, Chu-Na Chen^{2

3}, Chu-Qiao Li¹, An-Qi Jiang¹, Chong-Xin Li⁴, Yao Wang¹, Ge Tian¹, Su-Yue Pan¹, Ling-Ling Xu^{2

3}

Affiliations

¹ Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
² Department of Endocrinology, Shenzhen Hospital, Southern Medical University, Guangzhou, China.
³ The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.
⁴ Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.

Abstract

Background: There are many methods to diagnose diabetic autonomic neuropathy (DAN); however, often, the various methods do not provide consistent results. Even the two methods recommended by the American Diabetes Association (ADA) guidelines, Ewing's test and heart rate variability (HRV), sometimes give conflicting results. The purpose of this study was to evaluate the degree of agreement of the results of the Composite Autonomic Symptom Score 31 (COMPASS-31), skin sympathetic reaction (SSR) test, Ewing's test, and HRV in diagnosing DAN. Methods: Patients with type 2 diabetes were recruited and each received the COMPASS-31, SSR, Ewing's test, and HRV for the diagnosis of DAN. Patients were categorized as DAN(+) and DAN(-) by each of the tests. Kappa consistency tests were used to evaluate the agreement of diagnosing DAN between any two methods. Spearman's correlation test was used to evaluate the correlations of the severity of DAN between any two methods. Receiver operating characteristic (ROC) analyses were used to evaluate the diagnostic value and the cutoff value of each method. Results: A total of 126 type 2 diabetic patients were included in the study. The percentages of DAN(+) results by HRV, Ewing's test, COMPASS-31, and SSR were 61, 40, 35, and 33%, respectively. COMPASS-31 and Ewing's test had the best agreement for diagnosing DAN (κ = 0.512, p < 0.001). COMPASS-31 and Ewing's test also had the best correlation with respect to the severity of DAN (r = 0.587, p < 0.001). Ewing's test and COMPASS-31 had relatively good diagnostic values (AUC = 0.703 and 0.630, respectively) in the ROC analyses. Conclusions: COMPASS-31 and Ewing's test exhibit good diagnostic consistency and severity correlation for the diagnosis of DAN. Either test is suitable for the diagnosis of DAN and treatment follow-up.

Keywords: COMPASS-31; Ewing's tests; diabetic autonomic neuropathy; diagnosis agreement; diagnostic methods; heart rate variability; skin sympathetic reaction.