Menu

Tag Archive: diabetes

1. Multi-frequency Vibrometry Demonstrates Strong Correlation with Nerve Conduction Velocity in Detection of Diabetic Peripheral Neuropathy

   January 15, 2024 2:06 pm Leave a Comment

   This fresh research out of Sweden by Ekman et al assessed the ability of multiple vibration frequencies to detect diabetic peripheral neuropathy (DPN). They found that combinations of high (125 Hz and 250 Hz) and low ( 4 Hz and 8 Hz) frequencies were most effective with an area under the curve (AUC) of 0.83. They subsequently searched for correlations  between vibration testing and nerve conduction velocity (NCV) testing. Interestingly, the strongest correlation with NVC testing was noted when results from the sural nerve were negatively correlated the 5th metatarsal head vibration testing at 125 Hz ((Spearman correlation: r=-0.715, p<0.0001). This varies from current clinical practice guidelines recommending vibration testing with a 128 Hz tuning fork applied to the dorsal aspect of the interphalangeal joint of the great toe.

   Another interesting finding in the results but not discussed in the paper were the correlations of NCVs and vibration testing at 64 Hz and 125Hz at the first metatarsal head. Positive correlations of r=0.66 (64 Hz) and r=0.64 (125 Hz) were noted. These correlations support current clinical practice guidelines and may suggest that 64 Hz is a good alternative to use of the 128 Hz tuning fork. Our ETFMx offers multiple frequencies for those providers interested in expanding their options in this regard.

   

    

    

2. “Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers” from Diabetes Care

   January 20, 2023 5:42 pm Leave a Comment

   A recently published article in Diabetes Care, Etiology, Epidemiology, and Disparities in the Burden of Diabetic Foot Ulcers, is one of the most comprehensive reviews on the topic in the last several years. Disturbing trends in healthcare disparities for lower income and minority patient populations with diabetic foot ulcers (DFUs) are discussed. Another concern noted in the article is the uptick in the amputation rate in diabetes patients after some notable reductions in the 1990s and 2000s.  The importance of preventative care and screening is reviewed in detail. Specifically, diagnosing loss of protective sensation (LOPS) through testing with the Semmes-Weinstein monofilament and tuning fork is stressed in these patients due to the centrality of diabetic peripheral neuropathy (DPN) in the formation of most DFUs. These recommendations support the findings of our last article on the prediction of DFUs with these two screening tests.

   

3. ETF128 selected for vibration testing in Benfotiamine clinical trials

   July 21, 2022 6:18 pm Leave a Comment

   The company was please to learn that the ETF128 will be one of the vibration testing methods utilized in an international clinical trial assessing the effects of benfotiamine on patients with diabetic peripheral neuropathy (DPN). This randomized, double-blind, placebo-controlled study will compare  benfotiamine 300 mg twice per day to placebo over 12 months. Vibration testing with the ETF will be one of several nerve function tests measuring secondary endpoints. We are looking forward to the outcomes of this well-designed study as benfotiamine is one of the most promising supplements on the horizon for patients with DPN.

4. Rising prevalence of peripheral neuropathy in pre-diabetes patients

   May 28, 2021 8:15 am Leave a Comment

   Kirthi et al. just published a much needed systematic review looking at the rise of peripheral neuropathy in pre-diabetes patients. Not surprisingly, they noted a higher than expected prevalence of neuropathy in this patient population. Interestingly, abnormal small nerve fiber parameters were most notable in this group. This finding aligns with the current consensus that small fiber precedes large fiber degeneration in diabetes. They conclude, “Given the marked rise in pre-diabetes, further consideration of targeting screening in this population is required. Development of risk-stratification tools may facilitate earlier interventions.”

    

   

5. New Study Finds Younger Patients with Diabetes Experiencing Increased Hospitalization due to Diabetic Foot Ulcers

   January 17, 2021 2:50 pm Leave a Comment

   Hamilton et al. just published an article in Diabetes Care highlighting a disturbing trend previously discussed in this blog. In their comprehensive study spanning 24 years, Hamilton et al. compared the incidence of hospitalization in two temporally-distinct cohorts of patients with diabetes with and without diabetic foot ulcers (DFUs).  They found the overall incidence of DFU hospitalizations was increased over time. Just as concerning, this incidence was increased in younger patients in the more recent group. This mirrors findings by Geiss et al. who demonstrated a resurgence of Lower Extremity Amputations (LEAs) in middle-aged and younger adults with diabetes. Additionally, this trend toward younger patients experiencing DFUs was noted in a pending publication by Dr. O’Brien evaluating the combined value of the Semmes-Weinstein monofilament and the ETF128 in predicting DFUs. Overall, movement toward earlier diabetes diagnosis with its attendant complications appears to be emerging. Some speculation has tied this tendency to behavioral and lifestyle choices made by younger patients, thus highlighting the need for improved patient education and compliance with preventative care recommendations.