Advances in Screening, Early Diagnosis and Accurate Staging of Diabetic Neuropathy

Abstract

The incidence of both type 1 and type 2 diabetes is increasing worldwide. Diabetic peripheral neuropathy (DPN) is among the most distressing and costly of all the chronic complications of diabetes and is a cause of significant disability and poor quality of life. This incurs a significant burden on health care costs and society, especially as these young people enter their peak working and earning capacity at the time when diabetes-related complications most often first occur. DPN is often asymptomatic during the early stages; however, once symptoms and overt deficits have developed, it cannot be reversed. Therefore, early diagnosis and timely intervention are essential to prevent the development and progression of diabetic neuropathy. The diagnosis of DPN, the determination of the global prevalence, and incidence rates of DPN remain challenging. The opinions vary about the effectiveness of the expansion of screenings to enable early diagnosis and treatment initiation before disease onset and progression. Although research has evolved over the years, DPN still represents an enormous burden for clinicians and health systems worldwide due to its difficult diagnosis, high costs related to treatment, and the multidisciplinary approach required for effective management. Therefore, there is an unmet need for reliable surrogate biomarkers to monitor the onset and progression of early neuropathic changes in DPN and facilitate drug discovery. In this review paper, the aim was to assess the currently available tests for DPN’s sensitivity and performance.

Shear wave elastography as a quantitative biomarker of diabetic peripheral neuropathy: A systematic review and meta-analysis

“…Diabetic peripheral neuropathy (DPN), the main type of diabetic neuropathy, is one of the most common and serious complication of diabetes and the strongest initiating risk factor for diabetic foot ulceration, occurring in about 50% of patients with diabetes (3,4). This percentage is even higher, up to 60-90% in some areas (5,6).…”

Detecting Peripheral Neuropathy in Patients with Diabetes, Prediabetes and other High-Risk Conditions: An Advanced Practice Nurse’s Perspective

“…The ADA recommends annual PN screening for all DM patients (beginning at the time of a type 2 DM diagnosis and 5 years following a type 1 DM diagnosis) by history, physical examination including ankle reflexes, either pinprick or temperature sensation (to assess small fiber disease), vibration sensation with tuning fork (to assess large fiber disease), and 10g monofilament testing for sensitivity to light pressure to assess for LOPF and risk for foot ulceration [ 3 ]. Screening or composite questionnaires, such as the Michigan Neuropathy Screening Instrument, which combines screening questions, foot exam, and neurologic assessment, are widely used [ 37 ].…”

“…In some studies, 10 g monofilament examination has been shown to differentiate DM patients with and without neuropathy, and, along with the 128 Hz tuning fork, are widely employed in routine clinical practice [ 40 , 41 ]. However, similar to the lack of a strong recommendation for PN testing among patients in prediabetes, relying solely upon methods that detect large fiber, ie., later stage or mixed type, PN is controversial, as it may contribute to an underdiagnosis of cases, especially those characterized by pure small fiber neuropathology and those in an early stages [ 37 ].…”

“…For a more comprehensive exploration of DPN diagnostic methodology, including advantages and limitations of bedside and confirmatory options which is beyond the scope of this article, the reader is referred to a recent review by Carmichael and colleagues [ 37 ].…”

Immunoaffinity Capillary Electrophoresis in the Era of Proteoforms, Liquid Biopsy and Preventive Medicine: A Potential Impact in the Diagnosis and Monitoring of Disease Progression

“…For decades, we have known that disease manifests before it is clinically apparent or, in other words, before it manifests with symptoms and signs recognizable to patients and their health providers [9][10][11]. Many chronic diseases are "silent" and may take several years to manifest [12][13][14][15][16][17][18]. In 1999, for example, a large prospective study on Type 2 Diabetes Mellitus published in the United Kingdom demonstrated that pancreatic beta-cell dysfunction starts almost a decade before patients are diagnosed with Type 2 Diabetes Mellitus [19,20].…”