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Tests For Diabetic Neuropathy

Which Test For Diagnosing Early Human Diabetic Neuropathy?

Which Test For Diagnosing Early Human Diabetic Neuropathy?

Epidemiological studies show that diabetic neuropathy can affect 50–90% of patients with diabetes. Diabetes increases the risk of foot ulceration and amputation more than 23-fold (1), and neuropathy is the major contributory factor to this increased risk. Neuropathy presents as painful neuropathy in ∼20% of patients (2), and it independently predicts all-cause and diabetes-related mortality (3). Several longitudinal studies have shown that glycemic control and vascular risk factors are important in the development of diabetic neuropathy in patients with both type 1 (4) and type 2 (5) diabetes. However, the time of onset and exact deficits associated with early diabetic neuropathy have not been established using a comprehensive neuropathy assessment. In an early study of 132 newly diagnosed patients with type 2 diabetes, symptoms and clinical signs of neuropathy had a low prevalence (1.5 and 2.3%, respectively), while polyneuropathy assessed by electrophysiology was identified in 15.2% of patients and autonomic neuropathy based on an abnormal expiration-to-inspiration ratio was increased threefold compared with healthy control subjects (6). In a 5-year follow-up of this cohort, there was only a minimal deterioration in electrophysiology (7). The latest recommendations continue to advocate a multimodal approach to assessing diabetic neuropathy. This should include symptoms and signs, quantitative sensory testing, and electrophysiology (8). There is no doubt that symptoms and neurological deficits matter most to patients. However, the excessive variability and poor reproducibility (9) of these measures limit their utility in observational studies as well as in clinical trials. Although neurophysiology has been considered to be the most objective measure of diabetic neu Continue reading >>

Diagnosis

Diagnosis

Print Diabetic neuropathy is usually diagnosed based on your symptoms, your medical history and a physical exam. During the exam, your doctor is likely to check your muscle strength and tone, tendon reflexes, and sensitivity to touch, temperature and vibration. Your doctor may also conduct tests that include: Filament test. Sensitivity to touch may be tested using a soft nylon fiber called a monofilament. Nerve conduction studies. This test measures how quickly the nerves in your arms and legs conduct electrical signals. It's often used to diagnose carpal tunnel syndrome. Electromyography (EMG). Often performed along with nerve conduction studies, electromyography measures the electrical discharges produced in your muscles. Quantitative sensory testing. This noninvasive test is used to assess how your nerves respond to vibration and changes in temperature. Autonomic testing. If you have symptoms of autonomic neuropathy, your doctor may request special tests to look at your blood pressure in different positions and assess your ability to sweat. The American Diabetes Association recommends that all people with diabetes have a comprehensive foot exam — either by a doctor or by a foot specialist (podiatrist) — at least once a year. In addition, your feet should be checked for sores, cracked skin, calluses, blisters, and bone and joint abnormalities at every office visit. Treatment Diabetic neuropathy has no known cure. Treatment for diabetic neuropathy focuses on: Slowing progression of the disease Relieving pain Managing complications and restoring function Slowing progression of the disease Consistently keeping blood sugar within a target range can help prevent or delay the progression of diabetic neuropathy and may even improve some of the symptoms you already have. Continue reading >>

Diabetic Neuropathydiabetic Neuropathy Symptoms, Causes, Diagnosis, And Treatment

Diabetic Neuropathydiabetic Neuropathy Symptoms, Causes, Diagnosis, And Treatment

Diabetic neuropathy definition and facts Diabetes is thought to damage nerves as a result of prolonged elevated levels of blood glucose. Peripheral neuropathy most commonly causes: Autonomic neuropathy causes symptoms related to dysfunction of an organ system, such as: Diagnosis of diabetic neuropathy is usually done by a clinical exam. There is no cure for diabetic neuropathy, but treatments are available to manage the symptoms. Diabetic nerve pain may be controlled by medications such as tricyclic antidepressants, duloxetine (Cymbalta), or certain antiseizure medications. Keeping tight control of blood sugar levels is the best way to prevent diabetic neuropathy and other complications of diabetes. Diabetic Peripheral Neuropathy: Improve Diabetes Nerve Pain What are the symptoms and signs of diabetic neuropathy? The symptoms and signs of diabetic neuropathy depend upon the type of neuropathy that is present. Signs and symptoms can also vary in severity among affected people. Signs and symptoms of diabetic peripheral neuropathy include: Numbness or tingling of the feet and lower legs Pain or burning sensations Loss of sensation in the feet or lower legs Sometimes, but less commonly, these symptoms can occur in the hands or arms Signs and symptoms of diabetic proximal neuropathy include: Pain, usually on one side, in the hips, buttocks, or thighs Signs and symptoms of diabetic autonomic neuropathy depend upon the organ system that is involved and can include: Feeling full after eating a small amount Inability to empty the bladder completely Decrease in vaginal lubrication in women Rapid resting heartbeat Signs and symptoms of diabetic focal neuropathy also depend upon the location of the affected nerve. The symptoms can appear suddenly. It usually does not cause a long t Continue reading >>

Comparison Of Different Screening Tests For Diagnosis Of Diabetic Peripheral Neuropathy In Primary Health Care Setting

Comparison Of Different Screening Tests For Diagnosis Of Diabetic Peripheral Neuropathy In Primary Health Care Setting

Comparison of different screening tests for diagnosis of diabetic peripheral neuropathy in Primary Health Care setting Correspondence: Dr. Metab Al-Geffari, College of Medicine, Qassim University, P.O. Box: 1047, Qassim, Buraidah, 51431, Saudi Arabia, Mobile: 00966-504-950590,, E mail: [email protected] This article has been cited by other articles in PMC. DPN is an important complication and contributes to the morbidity of diabetes mellitus. Evidence indicates early detection of DPN results in fewer foot ulcers and amputations. The purpose of this study was to compare different screening tests in the detection of DPN in primary care setting. It is a cross-sectional study in a random sample (N = 242) of type 2 diabetes mellitus participants at primary care setting. Different screening tests for detecting DPN such as Michigan Neuropathy Screening Instrument (MNSI), Semmes-Weinstein Monofilament (SWM), vibration sensation and ankle reflex were performed for each patient and compare between them. 45% of the participant had DPN based on MNSI, The detection rate using the 128-Hz tuning fork and 10-g SWM was nearly same (32.6 & 31.4%) respectively and significantly higher than ankle reflexes (23.1%). Although, the prevalence of DPN determined by the combined two tests (38.79%) was higher than that through the single test. this study showed different results of DPN screening tests, even in the same group of patients. However there was a significant correlation between them. 128-Hz tuning fork and 10-g SWM monofilament would appear to be an appropriate, cheap and easy to use tool for identifying patients at risk of having neuropathy in primary care setting. Diabetic Peripheral Neuropathy (DPN) is one of the most common complications of diabetes and stands as a major pathoph Continue reading >>

How To Diagnose Diabetic Peripheral Neuropathy

How To Diagnose Diabetic Peripheral Neuropathy

How To Diagnose Diabetic Peripheral Neuropathy Diabetic peripheral neuropathy (DPN) is a diagnosis of exclusion. Diagnostic challenges are one thing but few practitioners relish that phrase when it comes to DPN. For this condition, the practitioner needs to cast a very wide net of tests and keep an open mind regarding clinical suspicion in order to reach an accurate diagnostic conclusion. How likely is it that there could be another neuropathy-causing disease or medical condition resulting in these same lower extremity symptoms? Does the podiatric physician really need to consider thyroid problems, vitamin B12 deficiencies, nerve entrapments, lupus, kidney failure, nutritional deficiencies and alcoholism among other diagnoses? Noted Mayo Clinic researcher Peter J. Dyck, MD, strongly cautions that the physician diagnosing DPN must first eliminate the presence of other neuropathy-inducing conditions because there is an estimated 10 percent occurrence of other neurologic diagnoses in patients who have concurrent diabetes. To fail to diagnose and treat these other conditions (or make an appropriate referral to other physicians) could be catastrophic for the patients outcome.1 That said, it is neither an easy nor inexpensive task to eliminate that 10 percent of outlying cases. The potential list of comparisons is a long one with vague symptoms. Indeed, when you treat patients with diabetes, you likely hear these common comments: My feet burn. I feel electric shocks in my toes. My toes are numb at the end of the day. I cant get to sleep at night because my feet feel like they are on fire. There was a time when a patients complaints of symptomatic or painful neuropathy led to commiseration from the physician but not much else because there were no distinctly good treatments. Continue reading >>

Diabetic Neuropathy - Exams And Tests

Diabetic Neuropathy - Exams And Tests

A diagnosis of diabetic neuropathy is based largely on your symptoms, medical history and physical examination. During a physical exam, your doctor may check how well you feel light touch, temperature, pain, vibration, and movement. Your doctor may also check your strength and reflexes. Electromyogram (EMG) and nerve conduction studies may be done to confirm a diagnosis. These tests measure how well and how quickly the nerves conduct electrical impulses. When nerve damage is present, the speed of nerve function slows. Problems linked with autonomic neuropathy-which affects the nerves that control internal functions-can be hard to diagnose. When new symptoms develop, more testing may be needed to diagnose the problem, identify the cause, and guide treatment. For example, a study that measures how fast your stomach empties may be done if symptoms like bloating, indigestion, or vomiting suggest gastroparesis, a condition that causes the stomach to take too long to empty. Nerve problems in people who have diabetes may be caused by other conditions, such as kidney disease, alcohol dependence, or a vitamin B12 deficiency. A variety of laboratory tests (such as a complete blood count) may be used to screen for conditions other than diabetes that could be causing symptoms. Your symptoms and medical history will determine which tests are needed. For some diseases, doctors can use screening tests to look for problems before you have any symptoms. But doctors can't test for all types of autonomic or focal neuropathy. So it is important to report to your doctor any pain, weakness, or motor problems you have. Also mention any changes in digestion, urination, sexual function, sweating, or dizziness. Your doctor will also look for signs of autonomic neuropathy during your physical exa Continue reading >>

Diabetic Neuropathy Test

Diabetic Neuropathy Test

Medoc > Application > Clinical Use > Diabetic Neuropathy Test Diabetic neuropathy test is a method of defining damage to nerves in the body which occurs due to high blood sugar levels from diabetes, and related decreased blood flow. Over time excess blood glucose can injure the walls of tiny blood vessels which nourish the nerves, especially in the legs. In the USA 15-20 million people over the age of 40 have neuropathy. About half of people with diabetes will develop nerve damage. Diagnosis of diabetic neuropathy is made based on the symptoms mentioned above as well as a physical exam blood pressure and heart rate, muscle strength, reflexes, sensitivity to position, vibration, temperature, or a light touch. The doctor may also run other diabetic neuropathy test to diagnose diabetic neuropathy in order to determine the extent of the nerve damage. These Diabetic neuropathy tests may include: nerve conduction tests, electromyography (EMG), quantitative sensory testing (QST), heart rate variability, ultrasound, nerve or skin biopsy. Diabetic neuropathy test from diagnosis to therapy Diabetic neuropathy is the clinical field in which QST has been most commonly applied, covering every aspect of the neuropathy, from diagnosis to therapy. QST diabetic neuropathy test was suggested as a tool for staging diabetic neuropathy by assessing the presence and severity of the neuropathy based on degree of warm and cold threshold abnormality. There is a significant correlation between the thermal abnormalities and the clinical bedside examination of small fiber function suggesting that these criteria could be used for long-term assessment of patients (Zaslansky and Yarnitsky, 1998). Researches show the importance of QST diabetic neuropathy test in early detection of dysfunctional unmye Continue reading >>

Diabetic Neuropathy Diagnosis

Diabetic Neuropathy Diagnosis

Your physician will conduct a medical history, physical exam, and even a pin-prick test to determine if you have diabetic neuropathy. In diagnosing diabetic neuropathy—also called diabetic nerve damage—your doctor may run a few exams and tests. He or she will also ask you about your symptoms. All this is done to get an accurate diagnosis. It's important to understand what type of diabetic neuropathy you have (diabetic peripheral neuropathy, proximal neuropathy, autonomic neuropathy, or focal neuropathy), as well as the extent of nerve damage. When describing your symptoms, be as specific as you can. The different types of diabetic neuropathy affect different nerves and cause different symptoms. Describing the severity and location of your pain (or other symptoms) will also help your doctor make an accurate diagnosis. Exams and Tests to Diagnose Diabetic Neuropathy The doctor will most likely perform a physical exam to assess your general physical condition, including your blood pressure, heart rate, reflexes, muscle strength, and ability to move. A critical part of the physical exam is a comprehensive foot exam. (People with diabetes should have a yearly foot exam.) In diabetic peripheral neuropathy—the most common type of diabetic neuropathy—the nerves in the feet and legs are usually the most damaged. Therefore, it's critical to check your foot health by assessing the circulation, bones, muscles, and skin. A neurological exam is also important in diagnosing diabetic neuropathy. Using various tests, the doctor will be able to determine how well your nerves are working. As mentioned before, different nerves transmit different messages; some are in charge of temperature and others deal with touch or vibration. By testing these different types of nerves, your doct Continue reading >>

Nervecheck: An Inexpensive Quantitative Sensory Testing Device For Patients With Diabetic Neuropathy

Nervecheck: An Inexpensive Quantitative Sensory Testing Device For Patients With Diabetic Neuropathy

NerveCheck: An inexpensive quantitative sensory testing device for patients with diabetic neuropathy Nervecheck is the first inexpensive ($500), portable device to quantify sensory loss. It measures the vibration, cold, warm perception threshold and heat pain threshold. It provide a simple categorical output of the severity of neuropathy. Its diagnostic accuracy for neuropathy is comparable to established QST devices. Sensory neuropathy is central to the development of painful neuropathy, and foot ulceration in patients with diabetes. Currently, available QST devices take considerable time to perform and are expensive. NerveCheck is the first inexpensive ($500), portable QST device to perform both vibration and thermal testing and hence evaluate diabetic peripheral neuropathy (DPN). This study was undertaken to establish the reproducibility and diagnostic validity of NerveCheck for detecting neuropathy. 130 subjects (28 with DPN, 46 without DPN and 56 control subjects) underwent QST assessment with NerveCheck; vibration perception and thermal testing. DPN was defined according to the Toronto criteria. NerveCheck's intra correlation coefficient for vibration, cold and warm sensation testing was 0.79 (95% LOA: 4.20 to 6.60), 0.86 (95% LOA: 1.38 to 2.72) and 0.71 (95% LOA: 2.36 to 3.83), respectively. The diagnostic accuracy (AUC) for vibration, cold and warm sensation testing was 86% (SE: 0.038, 95% CI 0.790.94), 79% (SE: 0.058, 95% CI 0.680.91) and 72% (SE: 0.058, 95% CI 0.600.83), respectively. This study shows that NerveCheck has good reproducibility and comparable diagnostic accuracy to established QST equipment for the diagnosis of DPN. Continue reading >>

Neurological Examinations

Neurological Examinations

Neurology Exam Questions from Your Doctor You should be prepared to discuss your symptoms in detail with your doctor. Your doctor will ask you to describe your symptoms, when you experience them, how long the episodes last and the amount of discomfort or pain you experience. The more specific you can be about the tingling, numbness, weakness or other symptoms you are experiencing, the easier it will be for your doctor to understand your condition. Your doctor may also ask you general health questions that may seem unrelated to your symptoms, but are, in fact, important. These questions could be about whether or not you feel faint, nauseated or tired. The doctor may also ask if your bladder control and sexual function are normal. You will also be asked if you are suffering from any other illnesses and if you are taking medications. The physician will then perform a physical exam to test for loss of vibratory sensation. He or she will test ankle jerks and other reflexes. Sensations in the feet and hands will be evaluated with a pin. Since some neuropathies are hereditary , you doctor will ask if other members of your family have suffered from any type of neuropathy or neurological disorder. A neurological evaluation consists of a physical exam and a number of simple and painless tests. The purpose of these tests is to assess your neurological function, including your muscle strength, how your autonomic nerves are functioning, and your ability to feel different sensations. The neurologist may recommend certain diagnostic tests, depending on the patients symptoms, medical history and physical examination. Frequently the neurologist will recommend electrodiagnostic testing to measure the electrical activity of muscles and nerves. If necessary, the neurologist may also recom Continue reading >>

Evaluation And Prevention Of Diabetic Neuropathy

Evaluation And Prevention Of Diabetic Neuropathy

Diabetic Autonomic Neuropathy Diabetic autonomic neuropathy can develop in patients with type 1 or type 2 diabetes. Although autonomic neuropathy may occur at any stage of diabetes,3,4 usually it develops in patients who have had the disease for 20 years or more with poor glycemic control. The reported prevalence of diabetic autonomic neuropathy varies widely, depending on the cohort studied and the methods of assessment.7 In autonomic disease, the sympathetic, parasympathetic, and enteric nerves are affected. Myelinated and unmyelinated nerve damage is found. Diabetic autonomic neuropathy may lead to hypoglycemic unawareness and increased pupillary latency. Many investigators have considered autonomic neuropathies to be irreversible. However, cardiac sympathetic dysinnervation has been shown to regress with tight glycemic control.8 CARDIOVASCULAR AUTONOMIC NEUROPATHY The risk of cardiovascular events is at least two to four times higher in patients with diabetes.9 Cardiovascular neuropathy is a result of damage to vagal and sympathetic nerves. Clinical findings may include exercise intolerance, persistent sinus tachycardia, no variation in heart rate during activities, and bradycardia. Baroreceptor disease contributes to supine hypertension. In a patient with type 1 diabetes, an autonomic imbalance may result in a prolonged QT interval on the electrocardiogram (ECG), which may predispose the patient to life-threatening cardiac arrhythmias and sudden death.7 Diabetic neuropathy also can reduce appreciation of ischemic pain, which may delay appropriate medical therapy and lead to death.7 Orthostatic blood pressure measurements may be used to evaluate cardiovascular autonomic dysfunction.10 Stress testing should be considered before any patient with diabetes starts an exe Continue reading >>

Simple Tests To Screen For Diabetic Peripheral Neuropathy

Simple Tests To Screen For Diabetic Peripheral Neuropathy

Simple tests to screen for diabetic peripheral neuropathy To determine the diagnostic accuracy of each simple test as triage to screen for diabetic peripheral neuropathy (DPN) involving limbs within different settings, or as replacement of nerve conduction studies (NCS) for the clinical diagnosis of DPN involving limbs, with NCS as the reference standard. To estimate the relative accuracy of simple tests for screening DPN involving limbs, with NCS as the reference standard. To assess the impact of potential sources of heterogeneity on the performance of simple tests for DPN involving limbs: (1) related to the study population (spectrum of the disease: with versus without other vascular complications; symptoms of DPN: people with no neurological symptoms versus neurological symptoms (if available, positive versus negative neurological symptoms); duration of diabetes; level of glycosylated haemoglobin A1c (HbA1c) in adults: < 7% versus 7%; body mass index (BMI) in adults: < 25 versus 25 kg/m; types of diabetes: type 1 versus type 2 diabetes mellitus; age: < 18 years old versus 18 years old); (2) related to the simple tests (different thresholds; body sites tested; numbers of body sites tested; types of instrument; examiner's expertise: specialists in diabetes or neurology versus other healthcare professionals); (3) related to the reference standard (numbers of body sites tested with NCS; examiner's expertise: specialists in electrodiagnosis versus other healthcare professionals); (4) related to the healthcare setting (community versus outpatient setting versus inpatient setting); (5) related to the methodology based on the QUADAS-2 items ( risk of bias for patient selection, index test, reference standard, and flow and timing; concerns regarding applicability of patient Continue reading >>

Diabetic Neuropathy: Your Diagnosis

Diabetic Neuropathy: Your Diagnosis

If you've been diagnosed with prediabetes or type 1 or type 2 diabetes, getting checked for diabetic peripheral neuropathy—damage to nerves in your feet, lower legs, hands and elsewhere—is critical. Having this common condition diagnosed can help you get relief from nerve pain, protect your feet from small injuries before they become more serious, help you walk more easily if nerve damage is affecting your balance or coordination, and may motivate you to keep your glucose (blood sugar) within healthy limits and follow a healthy lifestyle strategies. This could prevent or delay the development of neuropathy if you have type 1 diabetes and may prevent or slow down the worsening of neuropathy if you have type 2 diabetes. That’s why the American Diabetes Association, the American Association of Clinical Endocrinologists1 and the American College of Endocrinology recommend screening for PDN when you are first diagnosed with type 2 diabetes or five years after a diagnosis of type 1 diabetes. After that, get rescreened every year. See your doctor sooner if you develop symptoms, such as pain, tingling or numbness in your feet between screenings. If you have prediabetes, ask your doctor about a PDN screening if you have symptoms, the ADA now recommends. 2 How Peripheral Neuropathy is Diagnosed Your screening may begin with a physical exam to assess your overall health – including your blood pressure, heart rate, reflexes, muscle strength, and ability to move. Your healthcare provider will ask you questions about your health and your symptoms; he or she will also run a few tests. In addition, your doctor will rule out other causes of nerve damage such as thyroid problems, vitamin B12 deficiency, infections like Lyme disease or hepatitis B, some medications and more. 3 A k Continue reading >>

Simple Screening Tests For Peripheral Neuropathy In The Diabetes Clinic

Simple Screening Tests For Peripheral Neuropathy In The Diabetes Clinic

OBJECTIVE— The utility of rapid and reliable sensory tests appropriate for the diagnosis of neuropathy in the diabetes clinic, rather than as prognostic tools for the prediction of foot complications, has been unclear because of limitations inherent in previous studies. Although clinical practice guidelines recommend annual screening for neuropathy, they are unable to support specific recommendations for screening maneuvers because of a lack of evidence for the validity of screening tests in the medical literature. The objective of this study was to assess the operating characteristics of four simple sensory screening maneuvers as compared with standardized electrophysiological tests in the diagnosis of distal symmetrical polyneuropathy. RESEARCH DESIGN AND METHODS— We assessed four simple tests (the 10-g Semmes-Weinstein monofilament examination [SWME], superficial pain sensation, vibration testing by the on-off method, and vibration testing by the timed method) in 478 subjects with independent blinded evaluations compared against the criterion standard of nerve conduction studies. We present receiver-operating characteristic (ROC) curves, positive and negative likelihood ratios, and sensitivity and specificity values for each test. RESULTS— The four simple screening maneuvers reveal similar operating characteristics. Cutoff points by ROC curve analyses reveal that a positive or abnormal test is represented by five incorrect responses of eight stimuli applied. A negative or normal test is represented by one or fewer incorrect responses of eight stimuli applied. By these criteria, the point estimates of the positive likelihood ratios for vibration testing by the on-off method, vibration testing by the timed method, the SWME, and superficial pain sensation test are Continue reading >>

Diagnostic Accuracy Of Monofilament Tests For Detecting Diabetic Peripheral Neuropathy: A Systematic Review And Meta-analysis

Diagnostic Accuracy Of Monofilament Tests For Detecting Diabetic Peripheral Neuropathy: A Systematic Review And Meta-analysis

Diagnostic Accuracy of Monofilament Tests for Detecting Diabetic Peripheral Neuropathy: A Systematic Review and Meta-Analysis 1Rehabilitation Medicine Center, West China Hospital of Sichuan University, Chengdu, China 2West China School of Medicine, Sichuan University, Chengdu, China 3Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong 4Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China Correspondence should be addressed to Yonghong Yang and Pu Wang Received 19 April 2017; Accepted 6 July 2017; Published 8 October 2017 Academic Editor: Konstantinos Papatheodorou Copyright 2017 Fengyi Wang et al. This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Objective. To systematically evaluate the diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. Methods. We searched EMBASE (OvidSP), MEDLINE (OvidSP), the Cochrane Library, and Web of Science to identify diagnostic accuracy trials of monofilament tests for detecting diabetic peripheral neuropathy. We used a hierarchical summary receiver operating characteristics (HSROC) model to conduct the meta-analysis of diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy. Results. A total of 19 comparative trials met the inclusion criteria and were part of the qualitative synthesis. Eight trials using nerve conduction studies as the reference standard were selected for the meta-analysis. The pooled sensitivity and specificity of monofilament tests for detecting diabetic peripheral neuropathy were 0.53 (95% confidence interval (CI) 0.3 Continue reading >>

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