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Background: Small fiber peripheral neuropathy (SFN) is emerging as a common complication in diabetes. Currently there are few, not easily available methods of determining the integrity of small nerve fibers. This study was designed to determine the utility of a noninvasive technique, contact heat-evoked potential stimulation (CHEPS), on the identification of SFN and compare it with standardized measures of diabetic peripheral neuropathy (DPN).

Subjects and Methods: We evaluated 31 healthy controls and 30 participants with type 2 diabetes and DPN using neurologic examination, nerve conduction studies (NCS), autonomic function tests, quantitative sensory tests (QSTs), and CHEPS. Contact heat was administered to the thenar eminence, volar and dorsal forearms, lower back, and distal lower limb. Evoked potentials were recorded from the skull vertex. Latencies and amplitudes were determined.

Results …