Peripheral Neuropathy: Sudomotor Testing is quickly becoming the standard for Primary Care.

Sudomotor Testing Matters More Than Ever.

With recent statistics showing 49% of all patients coming into a physician's office are either Diabetic or Prediabetic, the need for quick and accurate diagnostics has never been more important. Even more concerning, about 50% of individuals with Diabetes will develop some form of nerve damage, according to the American Diabetes Association (ADA).

The most common form of nerve damage is Diabetic Neuropathy which typically starts in the feet and gradually affects both legs and arms. Detecting this early is critical—but many traditional diagnostic methods are either invasive, uncomfortable or lack precision. If left untreated, it is highly likely that Diabetic Neuropathy will lead to amputations, most commonly a patient's foot.

Traditional Testing Methods for Peripheral Neuropathy

• EMG (Electromyography): Rarely a clear indicator for nerve damage as more of a muscle test, is usually uncomfortable and time-consuming, but still often recommended

• Sudomotor Testing: Recognized as an accurate, objective and quantifiable diagnostic 'screening' in clinical offices prior to referring out.

• Punch Biopsy: Invasive, requires healing time and isn’t well-tolerated by many patients, though it is still considered the gold-standard for diagnosing peripheral neuropathy.

• Dermatome Testing: Largely subjective, not quantifiable or easy to track a positive or negative trend.

The Case for Sudomotor Testing

Sudomotor Testing is steadily being adopted in primary care as a non-invasive, efficient, and accurate way to assess small fiber neuropathy and autonomic nerve function—especially in diabetic patients.

Sudomotor testing device used for small fiber neuropathy screening

What is Sudomotor Function?

Sudomotor function refers to the nerves that control sweat gland activity—part of the autonomic nervous system. Sudo specifically means 'sweat' in Latin. Damage to these small, unmyelinated C-fibers can indicate early-stage Peripheral Neuropathy, often before more obvious symptoms arise.

Benefits of Sudomotor Testing

• Non-invasive & Painless: No needles, no electric shocking, no discomfort.

• Fast: Takes 3 minutes to complete.

• Accurate: Targets the most sensitive nerve fibers for early detection.

• Objective data: Immediately generates a color-coded report with quantitative data.

• Reimbursable: Covered by most insurances, including Medicare.

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During the test, a subsensory electrical signal is passed through the hands and feet. This generates a bioelectrical conductance response—a measurable indicator of sudomotor nerve function. In many ways, this is like a nerve conduction latency, since the software is calculating a velocity of the signal in both hands and feet, and correlating them to each other. Ultimately, if a patient has significant 'latency', or a inhibited bioelectrical response, that would suggest nerve damage. These abnormal results suggest impaired small C-fiber nerve activity, which provides physicians with concrete objective data to contribute towards a formal diagnosis.

When should physicians utilize Sudomotor Testing

As with all diagnostic testing, what a patient's insurance declares as medically reasonable and necessary doesn't always line up with a healthcare professional that knows their patients, knows the medical history, family history, and is sitting face-to-face with that patient. However, patients that present symptoms of neuropathy—burning, tingling, numbness, weakness or pain are often going to benefit clinically from having a Sudomotor Test.

More often than not, healthcare providers are immediately referring out for an EMG / NCV and more often than not, get inconclusive results. This delays an effective care plan which can reduce symptoms and slow the progression of the disease. Ideally, early mitigation can help avoid unnecessary amputations as well.

If there are signs of neuropathy, you can begin a treatment plan or send them out for further testing, but with more information and justification for advanced testing.

Why You Should Incorporate Sudomotor Testing Into Your Practice

Adding Sudomotor Testing to your diagnostic workflow improves the patient experience, clinical accuracy, and practice efficiency. It helps catch early-stage diabetic neuropathy that might otherwise go undiagnosed until more serious damage occurs. The Sudomotor Test can also detect nerve 'latency' without the need for uncomfortable EMG's & NCV's!

As Diabetes and Neuropathy rates are skyrocketing, this tool represents current-day technology that is modern, patient-friendly and usually supported by reimbursement policies and growing clinical data.

Conclusion: Future-Proof Your Neuropathy Screening

Sudomotor testing is not just a diagnostic innovation—it’s what most healthcare providers want from EMG/NCV and aren't getting; a fast, painless and accurate test in their office for any patient that presents symptoms that suggest peripheral nerve damage or degeneration. The fact that it has an associated CPT code that most insurances are reimbursing is an added benefit to justify the investment.

Optimize your care. Detect neuropathy earlier. Invest in Sudomotor Testing.

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