Clinical Use, Interpretation, and Limitations of Sudoscan in Diabetes Care

Abstract Diabetic peripheral neuropathy (DPN) and diabetic autonomic neuropathy (DAN) are prevalent yet underdiagnosed complications. While not a replacement for traditional diagnostics, Sudoscan is a noninvasive, rapid diagnostic device that evaluates sudomotor function through electrochemical skin conductance (ESC), offering a promising tool for screening neuropathic complications in routine clinical settings. This practice point article is a narrative review of the indications, clinical utility, interpretation, and limitations of Sudoscan within diabetes clinics. Evidence suggests that Sudoscan demonstrates high sensitivity (up to 87.5%) and moderate specificity for detecting DPN and DAN. It provides objective, quick assessments, and its operation does not require specialized training, enhancing feasibility in primary care and specialty clinics. The ESC and cardiovascular autonomic neuropathy risk scores derived from Sudoscan correlate with established tests, such as nerve conduction studies and cardiovascular reflex tests. Furthermore, Sudoscan supports early detection, risk stratification, and monitoring of disease progression. Despite its advantages, Sudoscan's diagnostic accuracy can be influenced by factors such as age and ethnicity, and ESC thresholds remain an area requiring standardization. It is most effective when used as part of a broader diagnostic strategy. This article provides clinicians with practical guidance on integrating Sudoscan into diabetes care, thereby enhancing the early identification and management of neuropathic complications.