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Sudomotor dysfunction is a major clinical manifestation of diabetic autonomic neuropathy and is an early sign of prediabetes. SUDOSCAN™, a noninvasive and quick method was developed to assess sudomotor function based on measurement of the electrical current response of the skin when different rectangular pulses of low voltage amplitudes are applied on nickel electrodes. Electrochemical skin conductance is then calculated from the resulting voltage and the generated current. This leads to an accurate noninvasive way to predict dysglycemia, including type II diabetes, without fasting requirement due to the sensitivity of Ni electrodes to human eccrine glands sweat.

Key to putting prevention of diabetes into practice is finding the people with increased risk. Several tools are currently in use: oral glucose tolerance test, fasting glucose measurement and a number of questionnaires to identify those with increased risk. Each has its own advantages and disadvantages. One new tool that can identify those with increased diabetes risk is the EZSCAN™. This new diagnostic device developed by Impeto Medical uses the sweat gland function to detect risk for insulin resistance and diabetes. The basic pathophysiology behind this technology is supported by the growing number of clinical studies worldwide which show a strong association between small nerve neuropathies to insulin resistance and diabetes risk. Because the EZSCAN™ test takes only three minutes to run, is noninvasive and easy to operate, it is an ideal diagnostic tool for both the medical and paramedical setting. Several applications are possible: the EZSCAN™ can be used to monitor insulin resistance-based treatment, to diagnose increased diabetes risk and to aid proposing diabetes prevention programmes. EZSCAN™ has the potential to become a very useful tool in diabetes risk diagnostics. Br J Diabetes Vasc Dis 2011;11:204-209

EZSCAN(®) (Impeto Medical, Paris, France), a noninvasive device that assesses sweat gland dysfunction using reverse iontophoresis, also detects early dysglycemia. Given the interrelationships among dysglycemia, vasculopathy, and neuropathy, EZSCAN may detect kidney disease in diabetes (DKD).An EZSCAN score (0-100) was calculated using a proprietary algorithm based on the chronoamperometry analysis. We measured the score in 50 Chinese type 2 diabetes patients without DKD (urinary albumin-creatinine ratio [ACR]2.5 mg/mmol in men or ACR3.5 mg/mmol in women and estimated glomerular filtration rate [eGFR]90 mL/min/1.73 m(2)) and 50 with DKD (ACR ≥25 mg/mmol and eGFR60 mL/min/1.73 m(2)). We used spline analysis to determine the threshold value of the score in detecting DKD and its sensitivity and specificity.EZSCAN scores were highly correlated with log values of eGFR (r=0.67, P0.0001) and ACR (r=-0.66, P0.0001). Using a cutoff value of 55, the score had 94% sensitivity, 78% specificity, and a likelihood ratio of 4.2 to detect DKD with a positive predictive value of 81% and a negative predictive value of 93%. On multivariable analysis, DKD was independently associated with EZSCAN score (β=-0.72, P=0.02), smoking status (1=never, 0=current/former) (β=-2.37, P=0.02), retinopathy (1=yes, 0=no) (β=3.019, P=0.01), triglycerides (β=2.56, P=0.013), and blood hemoglobin (β=-0.613, P=0.04). Patients without DKD but low EZSCAN score (n=10) had longer duration of disease (median [interquartile range], 13 [9-17] vs. 8 [4-16] years; P=0.017) and were more likely to have retinopathy (36.7% vs. 5.1%, P=0.02), lower eGFR (98 [95.00-103] vs. 106 [98.5-115], P=0.036), and treatment with renin-angiotensin system blockers (81.8% vs. 25.6%, P=0.002) than those with a normal score.EZSCAN may detect high-risk subjects for DKD in Chinese populations.

Aims: This study done in subjects with an initial normal glucose tolerance (NGT) was to assess the ability of EZSCAN, a new device developed to evaluate sudomotor function, to predict future abnormalities in glucose tolerance. Methods: South Asian (Indian) subjects (n= 69, 48% male, mean age 42 ± 9 years, mean BMI 28 ± 5 kg/m 2 ) diagnosed as NGT with a previous oral glucose tolerance test (OGTT, T0) underwent a frequently sampled OGTT (FSOGTT), 8 months later (T8). At both times EZSCAN tests were done. Using the AUC glucose and AUC insulin measured by the FSOGTT, subjects were categorised as normal, high AUC insulin or isolated high AUC glucose . Odds ratio (OR) for having high AUC insulin or isolated high AUC glucose vs normal was computed by logistic regression analysis using EZSCAN risk classification at T0 as independent variable ( 65%=high risk). Results: At T8, 11 and 5 subjects developed impaired glucose tolerance and diabetes respectively. OR of having high AUC insulin or isolated high AUC glucose in the different risk groups was 6.19 (CI 95% 1.50 – 25.48, p = 0.0116) for high risk vs no risk and 3.0 (CI 95% 0.98 – 9.19, p = 0.0545) for intermediate risk vs no risk. Sensitivity of EZSCAN for early detection of these abnormalities in glucose tolerance was 77% while it was 14% for fasting plasma glucose and 66% for HbA 1C . Conclusions: Assessment of sudomotor function by EZSCAN, a sensitive method when compared with the con - ventional methods may be very useful to identify and manage subjects at risk for developing glucose intolerance.

Low DC active current through nickel electrodes applied on skin in places like hands, forehead and feet provides a novel non invasive diagnostic tool using reverse iontophoresis. This work describes the electrochemistry reactions involved and some medical applications, such as diagnostics of neuropathy, diabetes and cardiac diseases. Finally we provide evidence for the utility of this method through large clinical studies.