Magazine article Clinical Psychiatry News

Early Screening Needed to Detect Diabetic Neuropathy

Magazine article Clinical Psychiatry News

Early Screening Needed to Detect Diabetic Neuropathy

Article excerpt

NEW ORLEANS -- Diabetic neuropathy is underdiagnosed in everyday clinical practice, according to a study of 7,378 patients assessed at more than 2,000 primary care physician offices and endocrinology clinics.

A minority of patients with diabetic neuropathy do seek care for pain, but most have an insensate foot or feet and do not complain to their physicians about a lack of sensation. Thus routine screening is the only means to early detection and intervention, Dr. William Herman noted at the annual scientific sessions of the American Diabetes Association.

"The primary care encounter is often one of responding to symptoms. Unless you look for diabetic neuropathy and systematically test, you can miss the diagnosis," Dr. Herman, professor of internal medicine and epidemiology at the University of Michigan, Ann Arbor, added in an interview.

The physicians in the study enrolled up to four of their own patients with type 2 diabetes. Most of the doctors worked in primary care offices (88%), and the remainder (12%) practiced in endocrinology clinics.

The study is part of a larger, ongoing one designed to assess the use of insulin glargine (Lantus, Aventis) in 14,000 primary care patients with type 2 diabetes not responding to oral agents. Aventis sponsored both studies.

Dr. Herman and his colleagues initially asked the physicians whether they thought that the participating patient had neuropathy.

The discernment of the doctor was then compared with results of a monofilament foot examination. Physicians tested the plantar surface of the patient's big toe with two sizes of monofilament.

Patients able to feel both monofilaments were considered normal (no neuropathy). Those who could feel the larger (5.07 gauge) but not the smaller (3.61 gauge) were classified as having nonsevere neuropathy.

Those who could feel neither monofilament had severe neuropathy. Only 0.74% of patients reported an ability to feel the smaller, but not the larger, monofilament; these participants were excluded based on this "nonsense" test result, Dr. Herman said.

Of the 7,378 patients in the study, 4,628 (63%) did not have neuropathy. Physicians correctly identified the lack of neuropathy in 92% of these patients.

Physician perception was less accurate for identifying patients with neuropathy. Monofilament testing indicated that 2,209 (30%) of the patients had nonsevere neuropathy and 541 (7%) had severe neuropathy; doctors correctly identified 31% of those with nonsevere neuropathy and 66% of those with severe neuropathy. …

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