Tag Archive: ETF128

  1. 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.

  2. ETF Proof-of-Concept Study Cited in Two International Practice Guideline Documents

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    Although the International Federation of Diabetes (IDF) put out these clinical practice guidelines in 2017, we were gratified to see our 2014 ETF Proof-of-Concept study cited on page 19 of the document. We are cited in the section on using a 128 Hz tuning fork to assess diabetic peripheral neuropathy.

    We were equally excited to learn that this same article was cited in a more recent article in the European Journal of Vascular and Endovascular Surgery in July 2019. We were cited in Global Vascular Guidelines on the Management of Chronic Limb-Threatening Ischemia”.  This clinical practice guideline document cites us on page S31 discussing clinical testing for neuropathy. 


  3. Timed Vibration Testing aids in the Diagnosis of Distal Sensory Polyneuropathy

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    A new article written by  Prabhakar et al. has demonstrated the utility of timed vibration testing  in diagnosing distal sensory polyneuropathy (DSP) due to a variety of conditions. They utilized a 128 Hz tuning fork and a handheld stopwatch to time how long patients could feel the vibrations at the hallux, medial malleolus and tibial tuberosity. They noted sensitivity of  85% for the test. Additionally, they were able to conclude that patients with vibration sense lasting >8 seconds at the hallux were free of DSP. Coincidentally, this correlates well with the new 7 second cutoff for early neuropathy on the updated ETF.




  4. 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

  5. Diabetic Amputation Rates on the Rise

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    A new study by Geiss from Diabetes Care reveals a disturbing trend toward increasing rates of lower extremity amputations in young (18-44 y/o) and middle-aged (45-64 y/o) diabetic patients. This comes after a two-decade long decline in amputation rates in all diabetic patients. The study noted this upward spike in data collected from 2010-2015 in the US. As to the potential causes for this finding, the authors suggest a “fundamental failure” in amputation prevention. They go on to note:

    “Many amputations may be avoided through attention to self- and clinical care practices to manage risk factors, including glycemic control and cardiovascular disease risk factors, and through early detection and appropriate treatment of foot ulcers .
    Increasing rates of NLEAs (non-traumatic lower extremity amputations), particularly minor amputations, suggest either early prevention practices (e.g., self management education, appropriate footwear, foot exams, and identification of high-risk feet) might not be optimally performed to prevent foot ulcers and/or there may be delays in timely treatment of ulcers.”

    Indeed, this systemic failure to prevent these tragic events is a recurring frustration well known to those treating diabetic patients.  An aggressive team-based approach incorporating primary care, podiatry, diabetes educators, vascular surgeons, nutritionists and wound care specialists is required in addition to active and willing patient participation. Additionally, the importance of aggressive early prevention cannot be over emphasized. This is germane in the diabetic foot with regard to early detection of diabetic neuropathy. The graphic below illustrates the concept well. In essence, the earlier neuropathy is diagnosed, the earlier prevention can be implemented to avoid amputations. A worthy goal for patients and providers alike.

    Earlier diagnosis of neuropathy indicated by the yellow arrow could help avoid amputations through earlier preventative intervention.

    In contrast, current guidelines focus on identifying Loss of Protective Sensation (LOPS) as a trigger for prevention.