The company was gratified to learn that the American Diabetes Association’s new Standards of Medical Care in Diabetes recommendations for 2017 have advised screening of all diabetic patients for large fiber neuropathy with a 128Hz tuning fork. Furthermore, the recommendations cited testing both small and large fiber nerves. This welcome clarification better reflects our current understanding of diabetic peripheral neuropathy. Clinicians are advised that small nerve fiber screening may be done with temperature or pinprick testing. The standing recommendations for 10 gm monofilament testing and annual foot exams remains unchanged.
The importance of these recommendations is underscored by a recent report in JAMA indicating that healthcare spending on diabetes topped a list of the 155 most common disease conditions in the U.S.. Previous research has demonstrated that spending on diabetic foot complications alone may be as high as 33% of the economic burden of diabetes on the U.S. healthcare system. Both these findings support the strategic implementation of aggressive prevention including diabetic foot exams.