# Predicting diabetic retinopathy stages using a simple nerve conduction measuring device, DPNCheck®: a retrospective observational study

## TL;DR

This study shows that a simple nerve conduction device can predict the severity of diabetic retinopathy, helping patients seek timely eye care.

## Contribution

The study demonstrates the practical use of DPNCheck® as a DR severity predictor, offering a simpler alternative to conventional nerve conduction methods.

## Key findings

- eMBC scores from DPNCheck® were significantly associated with DR stages, independent of diabetes duration and HbA1c.
- ROC analysis identified eMBC cut-off values of 1.11, 1.51, and 1.51 for predicting DR severity scores ≥1, ≥2, and ≥3.
- An eMBC of 1.51 or higher strongly indicates preproliferative or proliferative DR, requiring urgent ophthalmology referral.

## Abstract

Diabetic retinopathy (DR) often remains asymptomatic until it reaches advanced stages, when delayed treatment can lead to irreversible visual impairment. To promote timely ophthalmology visits, this study investigated the utility of a simple nerve conduction device, DPNCheck®, as a predictor of DR severity. Previous research has established a relationship between diabetic neuropathy (assessed by conventional nerve conduction studies) and DR progression; however, the specialized equipment and expertise required limit its practicality. In contrast, DPNCheck® is a simpler alternative that quantifies neuropathy severity through the severity of the estimated modified Baba classification (eMBC).

Using electronic medical records (EHRs), we identified individuals with diabetes who underwent DPNCheck® and subsequent ophthalmologic assessment for DR. Based on age and sural nerve conduction data, an eMBC was calculated. Meanwhile, DR severity was scored using a modified Davis classification, defining four stages (DR severity scores 0–3).

Of 181 individuals extracted from our hospital’s EHRs, 146 were eligible for analysis. Ordinal logistic regression showed that eMBC was significantly associated with DR stage, independent of diabetes duration and HbA1c. Receiver operating characteristic (ROC) curve analyses yielded eMBC cut-off values of 1.11, 1.51, and 1.51 to predict DR severity scores of ≥1, ≥2, and ≥3, respectively. Sensitivities ranged from 0.67 to 0.78, and specificities from 0.66 to 0.81. An eMBC of 1.51 or above was strongly associated with preproliferative or proliferative DR, indicating a need for urgent ophthalmology referral.

DPNCheck®, a simple nerve conduction measurement device, may help predict DR severity and facilitate timely ophthalmologic care.