From the mechanism described, this would seem to be best at detecting degrees of small fiber autonomic neuropathy.

What also struck me, though not in a good way, is that the authors acknowledge that small fiber neuropathy is generally the first presentation in diabetics (it often remains predominantly so), that EMG/NCV cannot detect small-fiber neuropathy, but they sort of dismiss skin biopsy with the phrase "IENFD as a screening test for small-fiber dysfunction in diabetes cannot be used as a screening tool due to its invasiveness and need for high-level expertise in obtaining and interpreting the sample."

It would me much more instructive, and clinically convincing, to see how this method correlates with skin biopsy results, as the latter is the current gold standard for determining small-fiber neuropathy. Also, skin biopsy is hardly invasive and it is not hard to obtain samples--the biopsies are punch biopsies--though it does require electron microscopy and special stains to examine samples (which perhaps Singapore has limited or no access to). Perhaps this will be tried on a large scale at a neuropathy center soon.