Thermal Quantitative Sensory testing (QST) is routinely performed in various diabetes clinics around the world to monitor for small fiber abnormalities.
Diabetic peripheral neuropathy, often also characterized by small fiber damage, and peripheral arterial disease both put Diabetes patients at risk for limb amputation.
A recent prospective cohort study of 725 type 2 Diabetes patients showed a high prevalence (74.3%) of subclinical abnormal thermal thresholds (warm detection and cold detection thresholds) measured by the Q-Sense Thermal Sensory Analyzer (Sheen et al. 2018). In this study, associations between thermal thresholds, demographics, clinical, and laboratory measures were investigated.
This finding is especially important considering the fact that the calculated toe-brachial-index of systolic blood pressure was associated with abnormal thresholds in Diabetes patients without a history of heart disease. Additionally, age and male gender put the patient at an increased risk to small fiber dysfunction according to this data. Modifiable risk factors associated with abnormal thermal thresholds found by this study were fasting serum glucose and HbA1c.
The study shows the importance of monitoring small fiber function and blood glucose values as these are simple tests that may prevent future patient harm.
Sheen, Y. J., Li, T. C., Lin, J. L., Tsai, W. C., Kao, C. D., Bau, C. T., & Sheu, W. H. H. (2018). Association between thermal threshold abnormalities and peripheral artery disease in patients with type 2 diabetes. Medicine, 97(51).