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Tag Archive: diabetic peripheral neuropathy

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. New Study Finds Vibration Testing More Reliable than Monofilament over Plantar Calluses

   October 23, 2022 11:10 am Leave a Comment

   Wynands et al’s recently published “Does plantar skin abrasion affect cutaneous mechanosensation?” brings into focus the importance of plantar callus debridement.  This study measured skin thickness, hardness, monofilament threshold and vibration perception threshold (VPT) in healthy participants over plantar calluses before and after “abrasion” (debridement). The intervention group was compared to a matched control group without callus debridement. Findings included significantly reduced skin thickness and hardness as to be expected after callus debridement. Interestingly, VPTs at 30Hz and 200Hz were not significantly affected by debridement. Monofilament thresholds however were significantly improved after the intervention. This finding led the authors to conclude:

   “Since VPTs are not affected by skin properties, they are likely to be the best choice to analyze sensory deterioration in diabetic feet, where skin property changes could skew data of devices like monofilaments.”

   This recommendation aligns with American Diabetes Association Guidelines for using vibration(large-fiber function) and pinprick/temperature (small-fiber function) testing along with the 10g monofilament when testing for loss of protective sensation (LOPS) in patients with diabetes. Another conclusion drawn from this study is that callus debridement improves light touch perception in healthy study participants. Future studies might evaluate this intervention in patients with varying degrees of diabetic peripheral neuropathy (DPN). Perhaps in addition to reducing pressures on the skin, debridement also will be found to improve skin sensitivity in this at risk group. 

   

4. 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.

5. 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.”