Diabetic, Metabolic and other Peripheral Neuropathies

The Challenge

Over 135 million people worldwide suffer from diabetes, with 25% developing podiatric problems related to the disease, such as diabetic neuropathy. This neuropathy often causes severe pain and can be incapacitating. The World Health Organization (WHO) estimates the number of diabetes patients will reach 300 million by 2025. Four to five percent of health budgets are spent on diabetes-related illnesses, such as the management of diabetic neuropathy and its consequences. Methods are needed to quantitatively evaluate the integrity of both small and large-caliber sensory nerve fibers in order to detect and treat this condition early in its progression. Since diabetic neuropathy is an irreversible condition, early detection is a key factor for controlling and treating patients early before the disabling effects present.


The Science of Diabetic and Metabolic Neuropathy

Thermal testing is essential in the scientific evaluation of small-caliber A-Delta & C-Fibers, the primary transmitters of thermal and pain sensation. Quantitative Sensory Testing (QST), widely regarded as the “Gold Standard” of thermal testing, is the only test that quantitatively assesses function of somatic small fibers – from peripheral receptors through their central nervous system connections.

Research has shown that diabetic peripheral neuropathy afflicts the peripheral nerves, typically both small and large fibers, though this can be at different intervals. Findings indicate that quantitative assessment of thermal sensitivity (small-fiber testing) may be of value in the detection of early diabetic peripheral neuropathy, even in patients without symptoms or signs of a clinical neuropathy. Other research indicates that vibratory and thermal testing should be a primary screening test for diabetic peripheral neuropathy. Since small caliber fibers are affected before large fibers, testing the small fibers helps to detect small fiber diabetic peripheral neuropathy two to three years earlier than possible with traditional EMG tests.

Vibratory thresholds (large, A-beta fiber testing) have been described as an effective predictor of the risk of foot ulceration in diabetes. Several professional conferences and organizations recommend the use of QST in treating and monitoring patients at risk for diabetic and metabolic neuropathies.

In addition, peripheral neuropathy is found in most patients suffering from renal disease, with polyneuropathy one of the most common consequences of chronic renal failure The majority of these patients are asymptomatic, requiring electrophysiological testing to confirm the abnormality. The health of the peripheral nerve is recognized as an important, quantitative serial or longitudinal measure for effectiveness of dialysis in uremic neuropathy.

Applying Medoc Solutions in Diabetic and other Peripheral Neuropathies

Medoc TSA-II NeuroSensory Analyzer and the VSA-3000 Vibratory Sensory Analyzer enable quantitative evaluation of the integrity of both small and large-caliber sensory nerve fibers and provides quantitative evidence of neuropathy in uremic patients and those suffering from diabetic neuropathy. These advanced clinical tools allow physicians to intervene early in the progression of this condition, enhancing patients’ quality of life and reducing the healthcare costs.

Tests used in Diabetic Neuropathy and CIPN (Chemotherapy induced peripheral neuropathy)

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