The role of Sudoscan feet asymmetry in the diabetic foot

Prim Care Diabetes. 2020 Feb;14(1):47-52. doi: 10.1016/j.pcd.2019.05.003. Epub 2019 May 29.


The aim of this study was to investigate the role of Sudoscan asymmetry parameters in the diabetic foot.

Patients and methods: In this study we included 165 participants: 84 type 2 diabetes patients divided into three HbA1c matched groups - group 1: newly diagnosed diabetics (n = 31), group 2: people with longer diabetes duration and established neuropathy (n = 33), group 3: patients with diabetic foot ulcer (n = 20), and a control group of 81 people with prediabetes. All subjects underwent peripheral sudomotor evaluation using Sudoscan device (Impeto Medical, Paris).

Results: Patients with diabetic foot had significantly higher Sudoscan feet asymmetry (19.6%) compared to those with only diabetic neuropathy (7.9%), compared to the group with newly diagnosed diabetes (7.44%), and compared to controls (2.5%). This test has shown a good discriminative value (with a threshold of 9.5%) for diabetic foot with area under the ROC curve of 0.955 (p = 0.001). Additionally, in a regression model feet asymmetry proved its predictive value for participants with diabetic foot.

Conclusion: In this study Sudoscan feet asymmetry proved to be a novel discriminator and predictor for diabetic foot patients. It might be considered as a marker for early damage in the neuropathy evaluation protocol.

Keywords: diabetic foot; evaluation; neuropathy; sudomotor.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Biomarkers / blood
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetic Foot / diagnosis*
  • Diabetic Foot / etiology
  • Diabetic Foot / physiopathology
  • Diabetic Neuropathies / diagnosis*
  • Diabetic Neuropathies / etiology
  • Diabetic Neuropathies / physiopathology
  • Early Diagnosis
  • Female
  • Foot
  • Glycated Hemoglobin / metabolism
  • Hand
  • Humans
  • Male
  • Middle Aged
  • Neurologic Examination*
  • Predictive Value of Tests
  • Skin / innervation*
  • Sweating*


  • Biomarkers
  • Glycated Hemoglobin A
  • hemoglobin A1c protein, human