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Tag Archive: diabetic foot

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. ADA releases Standards of Care in Diabetes—2023

   December 17, 2022 3:36 pm Leave a Comment

   The American Diabetes Association just released their 2023 version of it’s Standards of Care in Diabetes. The Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes chapter again reflects the latest evidenced-based guidelines on the treatment of the diabetic foot. Some newer recommendations include topical oxygen therapy for recalcitrant diabetic foot ulcers and alpha lipoic acid for neuropathic pain. Testing patients with diabetes for Loss of Protective Sensation (LOPS) with a 10g monofilament and at least one other neurological screening tool is again advised. One of these approved methods includes vibration testing with the 128 Hz tuning fork or “similar device”. These guidelines are in agreement with our latest ETF research paper, Combined Utility of the Semmes-Weinstein Monofilament and the Timed Vibration Test in the Prediction of Diabetic Foot Ulcers.

   

3. 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.”

    

   

4. 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.

5. ETF Product Refresh 2019

   March 31, 2019 2:46 pm Leave a Comment

   The ETF was originally conceived as a way of assisting providers and patients in the prevention of diabetic foot complications through improved diagnosis and tracking of diabetic peripheral neuropathy (DPN). With this is mind, the company is pleased to announce our latest product updates. Customer feedback combined with the latest evidenced-based research has resulted in three product improvements.

   1. The vibration output has been adjusted to make the testing time two seconds shorter to diagnose early neuropathy. The old scale cut-off point was at nine seconds, the new one is set at seven seconds.
   2. The vibration output in the 128 Hz Mode at three seconds approximates the vibration level of the typical biothesiometer at the 25 volt level. This is the standard cut-off indicating increased risk of diabetic foot ulceration. Constant Mode is also set to the this level for those who prefer the On/Off Method of testing.
   3. The new labeling on the front of the device (see below) now reflects a risk-based stratification scale that is more clinically relevant. The 25 volt biothesiometer level is denoted at the three second mark on this scale.

   These changes will help improve the interpretation of test results and reduce testing time for providers.

   

   New ETF Risk Stratification Label