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Combined microvascular screenings effective in early detection of diabetic peripheral neuropathy
Adding a foot examination to an annual retinal screening for adults with diabetes may be an effective tool for the early diagnosis of peripheral neuropathy, according to data published in Diabetic Medicine.
“Given the rising tide of amputations in the U.K., there may be a good rationale for a robust, high-uptake [diabetic peripheral neuropathy] screening service, aimed at diagnosing the disease early at a point when it can be halted, in both type 1 and type 2 diabetes,” Solomon Tesfaye, MB ChB, MD, FRCP, consultant physician/endocrinologist at the Royal Hallamshire Hospital, Sheffield, U.K., and honorary professor of diabetic medicine at Sheffield Teaching Hospitals NHS Foundation Trust, and colleagues wrote. “The results of the present study show that combined eye, foot and renal screening in a one-stop microvascular screening clinic was feasible and had high patient acceptability and uptake. Moreover, this service was conducted by a podiatrist with the skills to assess foot risk and footwear and to refer at-risk patients appropriately.”
A podiatrist examined 236 patients with diabetes (mean age, 63.5 years; 61.4% men; 97.8% with type 2 diabetes) attending annual retinal screenings at Northern General Hospital, Sheffield, and the primary care office at Jordanthorpe Medical Centre, Sheffield, between 2015 and 2016. The assessment included an evaluation based on the Toronto Clinical Neuropathy Score, a 10-g monofilament test and two measures of neuropathy obtained using the point-of-care devices DPNCheck (Neurometrix) and Sudoscan (Impeto Medical), which were chosen for their portability, quick results and screening validation.
Forty-three percent of participants reported previously receiving basic foot care education; evidence of foot screening in the past year was documented for 18.9%. Among participants, 56.6% were found to have a moderate to high risk for foot ulcers, and 25% received a new diagnosis of painful distal symmetrical polyneuropathy.
The one-stop screening service was well-received by the patients with 91.1% reporting they were “in favor” or “strongly in favor” of the service, according to the researchers.
“Early identification of participants with insipient neuropathy using these validated, yet novel noninvasive methods will allow targeted intensified metabolic control and other potential new treatment interventions in order to prevent clinical [diabetic peripheral neuropathy] or halt disease progression,” the researchers wrote. –by Melissa J. Webb
Disclosures: The study was funded by Sheffield Teaching Hospitals NHS Foundation Trust. Tesfaye reports he has served on the scientific advisory boards of Impeto Medical and Neurometrix. Please see the study for all other authors’ relevant financial disclosures.