461-P: Diagnostic Accuracy of One Physical Examination Test vs. Three for Diabetic Peripheral Neuropathy Screening
Bibliographic record
Abstract
Introduction and Objective: ADA guidelines recommend using three physical examination tests (temperature or pinprick for small-fiber function, vibration for large-fiber function, and monofilament) for annual neuropathy screening. As some guidelines recommend choice of one test, we aimed to determine if the ADA strategy has better cross-sectional diagnostic accuracy over one test in adults with diabetes. Methods: We performed an updated analysis on baseline data from the Toronto Diabetic Neuropathy longitudinal cohort (N=478, 70 (15%) with T1D). 345(72%) participants had neuropathy according to the ‘Toronto Criteria’ nerve conduction study-based classification. Simultaneously, all underwent blinded assessment by independent examiners for pinprick, vibration (by the on-off method), and monofilament. Logistic regression and Area Under the receiver operating characteristic Curve (AUC) determined diagnostic accuracy for each testing strategy. Results: AUC for the combined three-test multiple logistic regression model was 0.84. Each of monofilament, pain, and vibration had slightly lower AUC (0.79, 0.75, and 0.74, respectively, p<0.001 for all comparisons). The optimal cut-point for the three-test model (predicted probability of 0.70) had sensitivity 80%, specificity 75%, likelihood ratio positive (LR+) 3.16, likelihood ratio negative (LR-) 0.27, and Diagnostic Odds Ratio (DOR) 11.7. The optimal cut-point for the single test with highest AUC (3 or fewer sensate monofilament responses out of 8) had sensitivity 67%, specificity 78%, LR+ 3.01, LR- 0.42, and DOR 7.2. Conclusion: The combined three-test ADA strategy had the best overall diagnostic accuracy. However, use of a single physical examination maneuver, such as the monofilament, had acceptable diagnostic performance. Future work should focus on the best strategy for prediction of future neuropathy onset. Disclosure A. Al Mulla: None. E. Parikh: None. L. Lovblom: None. A. Orszag: None. V. Bril: None. B.A. Perkins: Other Relationship; Abbott, Novo Nordisk, Sanofi. Advisory Panel; Abbott, Insulet Corporation, Sanofi, Novo Nordisk, Nephris, Vertex Pharmaceuticals Incorporated. Research Support; Novo Nordisk.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.012 | 0.029 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.002 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.002 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.003 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".