Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of…

Cohort studyJournal of the peripheral nervous system : JPNS· Mar 2026

Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk.

Ethan Parikh, Abdulrhman Al Mulla, Leif Erik Lovblom … Bruce A Perkins

NeuromuscularCohort studyQ2IF 2.8

Three-test screening did not outperform monofilament alone for predicting incident diabetic peripheral neuropathy

Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk.

Ethan Parikh … Bruce A Perkins

Journal of the peripheral nervous system · Mar 2026 · Q2 in Neurology

Background

The American Diabetes Association recommends three rather than one physical examination test for diabetic peripheral neuropathy (diabetic peripheral neuropathy) screening, although supporting evidence for the more complex screening strategy remains limited.

Purpose

We aimed to determine if a three-test strategy was superior to a single-test in sensitively identifying early stages of neuropathy risk.

Methods

Using longitudinal data from 170 adults without diabetic peripheral neuropathy, we compared the overall accuracy, represented by the area under the receiver operating characteristic curve (AUC), for the three-test versus one-test strategies.

n = 170 adults

Results

Predictive AUC of monofilament alone, matching the model-based three-test probability (0.71); 1.0 is perfect, 0.5 is chance.

Sum of Abnormal Tests

0.66AUC

Monofilament

0.71AUC

More results

Incident diabetic peripheral neuropathy occurred in 53 (31%) participants over a mean 4-year follow-up.

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Conclusion

A complex three-test strategy did not outperform the best-performing single-test strategy, implying that practice guidelines that recommend simplified approaches to neuropathy screening are valid.

Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk.

Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk.

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