Tag Archive: diabetic foot

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

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    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.”

     

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

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    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.

  3. ETF Product Refresh 2019

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    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

  4. New Study Confirms Neuropathy as Leading Risk Factor for Diabetic Ulcers

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    A large new study has found that 98% of those diabetic patients with foot ulcers had neuropathy signs. Kahn et al  assessed 2052 diabetic patients with and without diabetic foot ulcers (DFU).  The leading risk factor by far in the DFU group was neuropathy followed by obesity, waist circumference and dyslipidemia. Interestingly, over 17% of the total study population developed DFU.  These results confirm the primacy of neuropathy among risk factors precipitating DFUs and their attendant complications.

     

     

  5. MIPS Quality Measure #126-Diabetic Foot Neurological Exam

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    CMS has recently updated its MIPS (Merit-based Incentive Payment System) Quality Measures. Measure #126 continues to be retained for performance of neurological exams on the feet of diabetic patients. As Measure Steward for this indicator, APMA (American Podiatric Medical Association) has done an excellent job creating a flowchart on implementation. Consistent with prior years, evaluation includes at least annual testing with the 10 gm monofilament plus one of the following:

    Vibration Test Using 128 Hz Tuning Fork
    Pinprick Sensation
    Ankle Reflexes
    Vibration Perception Threshold

    O’Brien Medical is gratified to see that CMS has included vibration testing in two of its four recommended adjunct tests. This decision also reflects current ADA (American Diabetes Association) recommendations.