Improving Diagnostic Accuracy for Diabetic Neuropathy: Implementation and Evaluation of an Electrodiagnostic Protocol

Objective: Diabetic distal symmetric polyneuropathy (DSPN) is a common complication of type 2 diabetes mellitus (T2DM) that requires accurate and reliable diagnostic approaches. Existing diagnostic criteria lack sufficient specificity, creating the need for the development of a novel electrodiagnostic protocol. This study aimed to validate the clinical utility of this protocol.Methods: A retrospective analysis was performed in 220 patients with T2DM who were referred for DSPN screening. Nerve conduction studies (NCS) parameters, including compound muscle action potential (CMAP) of the tibial and peroneal nerves, sensory nerve action potential (SNAP) of the sural nerve, and F-waves, were systematically reviewed. Electrodiagnostic findings were correlated with neuropathic symptoms, duration of diabetes, and glycated hemoglobin levels.Results: Based on NCS findings, patients were stratified into normal, early, mild, moderate, and severe DSPN groups. Significant associations were identified between DSPN severity, symptom burden, and specific electrophysiological parameters, particularly tibial CMAP and sural SNAP amplitudes. The protocol enabled structured disease categorization and demonstrated strong diagnostic applicability across the full spectrum of DSPN severity.Conclusion: The proposed electrodiagnostic protocol provides a systematic and efficient approach for diagnosing DSPN in patients with T2DM. It highlights the diagnostic relevance of selected NCS parameters in relation to clinical symptomatology. Further prospective validation in larger and more diverse populations is warranted.