New ADA Compendia: DIAGNOSIS AND TREATMENT OF PAINFUL DIABETIC PERIPHERAL NEUROPATHY
An excellent new monograph was just released from the American Diabetes Association on diabetic peripheral neuropathy (DPN). This document, authored by a panel of experts on the subject, updates providers on the latest guidance for the diagnosis and treatment of DPN. Interestingly, a new appreciation for the impacts of the Social Determinants of Health (SDOH) on DPN was presented as well.
As expected, diagnosis of DPN is covered in detail. In accord with current ADA guidelines, the recommendation for testing with a 10-g monofilament and one other modality is advised. One of these ancillary exams is vibration sensation assessment with the 128 Hz tuning fork. As this passage below highlights, it is recommended that monofilament testing be paired with vibration or pinprick.
“Although the 10-g monofilament is arguably the most often used test to screen for DPN in routine care, its use alone is not recommended for effective screening or diagnosis, as the loss of light-touch sensation occurs in advanced stages of neuropathy, and relying solely on this test could miss opportunities to implement early preventive care measures in many people with DPN. Sensation testing with pin and vibration is more sensitive.” ¹
- https://diabetesjournals.org/DocumentLibrary/Compendia/ada_2022_neuropathy_compendium_fin-web.pdf accessed on 2-4-22.