{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T04:48:55Z","timestamp":1782103735485,"version":"3.54.5"},"reference-count":20,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/100013528","name":"Diabetes Canada","doi-asserted-by":"publisher","award":["AR\u20102\u201006\u20102056\u2010BP"],"award-info":[{"award-number":["AR\u20102\u201006\u20102056\u2010BP"]}],"id":[{"id":"10.13039\/100013528","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000064","name":"Banting and Best Diabetes Centre, University of Toronto","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000064","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004811","name":"World Meteorological Organization","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004811","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Peripheral Nervous Sys"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The American Diabetes Association recommends three rather than one physical examination test for diabetic peripheral neuropathy (DPN) screening, although supporting evidence for the more complex screening strategy remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>We aimed to determine if a three\u2010test strategy was superior to a single\u2010test in sensitively identifying early stages of neuropathy risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using longitudinal data from 170 adults without DPN, we compared the overall accuracy, represented by the area under the receiver operating characteristic curve (AUC), for the three\u2010test versus one\u2010test strategies. These were conducted for monofilament, pinprick, and vibration sensation compared to the Sum of Abnormal Tests (primary analysis) or a model\u2010based probability from quantitative scores for each test in the prediction of nerve conduction study\u2010defined incident DPN.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Incident DPN occurred in 53 (31%) participants over a mean 4\u2010year follow\u2010up. Predictive AUC for both the Sum of Abnormal Tests or the model\u2010based probability did not differ from the AUC for monofilament (0.66 vs. 0.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05 and 0.71 vs. 0.71,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.79, respectively).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>A complex three\u2010test strategy did not outperform the best\u2010performing single\u2010test strategy, implying that practice guidelines that recommend simplified approaches to neuropathy screening are valid.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jns.70114","type":"journal-article","created":{"date-parts":[[2026,3,10]],"date-time":"2026-03-10T01:19:34Z","timestamp":1773105574000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Overall Diagnostic Performance of Multiple Versus Single Physical Examination Tests for the Prediction of Future Diabetic Neuropathy Risk"],"prefix":"10.1111","volume":"31","author":[{"given":"Ethan","family":"Parikh","sequence":"first","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Temerty Faculty of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulrhman","family":"Al Mulla","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Endocrinology, Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6774-8924","authenticated-orcid":false,"given":"Leif Erik","family":"Lovblom","sequence":"additional","affiliation":[{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"},{"name":"Biostatistics Department University Health Network  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dalton R.","family":"Budhram","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Endocrinology, Department of Medicine University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrej","family":"Orszag","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcello","family":"Falappa","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hoda","family":"Gad","sequence":"additional","affiliation":[{"name":"Weill Cornell Medicine\u2010Qatar, Research Department  Doha Qatar"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5805-4883","authenticated-orcid":false,"given":"Vera","family":"Bril","sequence":"additional","affiliation":[{"name":"The Ellen and Martin Prosserman Centre for Neuromuscular Diseases University Health Network, University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0046","authenticated-orcid":false,"given":"Bruce A.","family":"Perkins","sequence":"additional","affiliation":[{"name":"Lunenfeld\u2010Tanenbaum Research Institute, Mount Sinai Hospital  Toronto Ontario Canada"},{"name":"Division of Endocrinology, Department of Medicine University of Toronto  Toronto Ontario Canada"},{"name":"Institute of Health Policy, Management and Evaluation University of Toronto  Toronto Ontario Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2023.1265372"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.2337\/dc24-S012"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcjd.2017.10.028"},{"key":"e_1_2_10_5_1","volume-title":"Diabetic Foot Problems: Prevention and Management. 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