Abstract： Objective:To investigate the value of nerve conduction velocity testing combined with F-waves, H-reflexes, and sympathetic skin responses in electroneuromyography in the diagnosis of diabetic peripheral neuropathy.Methods:A total of 212 patients with diabetic peripheral neuropathy who received treatment at Fenyang Hospital of Shanxi Province (Fenyang Hospital Affiliated to Shanxi Medical University) from October 2022 to October 2023 were included in this study. These patients were divided into an asymptomatic group ( n = 100) and a symptomatic group ( n = 112) based on the presence or absence of peripheral neuropathy symptoms. Additionally, 100 healthy individuals who underwent physical examinations at the same hospital during this period were included in the control group. Motor nerve conduction velocities were measured for the median nerve, ulnar nerve, tibial nerve, and common peroneal nerve, while sensory nerve conduction velocities were assessed for the median nerve, ulnar nerve, superficial peroneal nerve, and gastrocnemius nerve. F-waves were recorded for the median and tibial nerves. The H-reflexes of the tibial nerve and sympathetic skin response were also evaluated. Differences in motor nerve conduction velocity, sensory nerve conduction velocity, F-waves, H-reflexes, and sympathetic skin responses among the different groups were compared. Results:In the asymptomatic and symptomatic groups, motor conduction velocities were lower ( F = 390.32, 264.63, 228.58, 714.30), distal motor latencies were longer ( F = 316.87, 106.88, 108.58, 217.86), compound muscle action potential amplitudes were lower ( F = 113.38, 59.58, 14.92, 10.36), sensory conduction velocities were slower ( F = 568.87, 532.74, 973.75, 1181.27), sensory nerve action potential amplitudes were lower ( F = 229.53, 309.97, 251.07, 414.82), F-waves were longer ( F = 653.96, 538.20), H-wave latencies were longer ( F = 401.54), and sympathetic skin response latencies were also longer ( F = 147.93, 98.85) compared with those in the control group (all P < 0.05). There were significant differences in motor nerve conduction velocity ( t = 7.33, 13.31), distal motor latency ( t = 13.56, 4.34), compound muscle action potential amplitude ( t = 2.98, 2.99) of the tibial nerve and common peroneal nerve between the asymptomatic and symptomatic groups (all P < 0.05). Significant differences were also observed in the sensory nerve conduction velocity ( t = 12.85, 13.70, 11.08, 15.66) and sensory nerve action potential amplitude ( t = 20.15, 20.26, 8.96, 18.55) of the median nerve, ulnar nerve, gastrocnemius nerve, and superficial peroneal nerve (all P < 0.05). Additionally, differences in F-waves of the median and tibial nerves were significant ( t = 31.96, 13.70, both P < 0.05). The abnormal detection rate of nerve conduction velocity test in the asymptomatic group was 86% (86/100), while the abnormal detection rate of combined nerve conduction velocity test, F-waves, H-reflexes, and sympathetic skin response was 91% (91/100). In the symptomatic group, the abnormal detection rate of nerve conduction velocity test alone was 90.18% (101/112), and the abnormal detection rate of combined nerve conduction velocity test, F-waves, H-reflexes, and sympathetic skin responses was 98.21% (110/112). The abnormal detection rate of combined therapy in the symptomatic group was significantly higher than that in the asymptomatic group ( χ2 = 5.58, P = 0.018). Conclusion:Neuroelectromyography has high diagnostic value for diabetic peripheral neuropathy. The use of F-waves, H-reflexes, and sympathetic skin responses, in conjunction with nerve conduction velocity testing, can enhance the early diagnosis of diabetic peripheral neuropathy in patients who do not exhibit peripheral neuropathy symptoms.