INTRODUCTION: Diabetes and Chronic Kidney Disease (CKD) are two distinct pathologies with a common complication:
the peripheral neuropathy (PN) defined as a progressive degeneration of sensory and motor neurons, leading to a wide
range of painful symptoms while impairing force production capacity. PN can affect more than 50% of these patients. If PN
is not identified in time, it can worsen and may require limb amputation, which is a dramatical burden for patients and
society. Among the diagnostic tests available, clinical assessments suffer from time-consuming protocols and a high
variability due to human subjectivity, while electrophysiological tests remain difficult-to-access and can only detect large
axons only, in the later stages. Our recent findings suggest that the quantification of postural balance and single-leg
balance time has been shown to accurately predict diabetes-related PN. Therefore, the aim of the current study is to validated
these previous results and to collect diversified physical and balance performance tests in order to determine
whether physical performances can accurately predict PN in individuals with diabetes and CKD.
METHODS: The study is prospective and interventional. Inclusions lasted from February to May 2025 in endocrinology and
nephrology outpatients’ unit. The inclusion criteria require participants to be aged between 60 and 80 years, with a body
mass index ≤35 kg.m-2 and a diagnosis of diabetes (type I or II) and/or CKD with a renal function <30 ml/min not in
dialysis. The exclusion criteria include disabling cognitive, neurological, musculoskeletal, osteoarticular comorbidities or
recent lower limb fractures.
Participants were tested for PN using the validated Michigan Neuropathy Screening Instrument. They performed 6 tests in
order to quantify walking abilities, proprioceptive performances and lower-limb muscle force: 10m walk test, timed-up
and go, joint position sense, star excursion balance test, balance tests and ankle muscles strength assessment. The predictive
equation will be developed using a regression method.
RESULTS: Given the previous results reporting a very high area under the ROC curve (0.960), a high specificity (97.4%) with
moderate sensitivity (77.8%) using balance tests compared to clinical diagnosis, the expected results of the present study,
focusing even more on proprioceptive capabilities, are promising.
CONCLUSION: Due to the limited availability and reliability of screening tools, many patients live with undiagnosed PN,
which can lead to severe consequences in the event of foot injuries or bedsores. Physical performance declines even in
the early stages of PN, accompanied by intrinsic foot muscle remodeling and gait impairments. A systematic, low-cost,
rapid, and validated method for estimating PN risk would facilitate timely medical referral, thereby reducing the physical
and socioeconomic burden of undiagnosed PN in patients with diabetes and CKD.