ADA: Large Number of Neuropathy
Diagnoses Missed
Family doctors miss diagnosis of peripheral
neuropathy 66% of the time and endo’s miss
it 25% of the time.
This finding of a large cohort study was presented
by William H. Herman, MD, of the University of
Michigan at Ann Arbor, at the American Diabetic
Association 63rd Scientific Sessions.
The ongoing study, whose objective is to screen
for the presence of neuropathy in a large population
of patients predominantly treated in a primary
care setting, has so far yielded data for 7,378
patients.
Eighty-eight percent of the patients were seen
by a primary-care doctor, and the rest by endocrinologists,
said Dr. Herman, speaking on behalf of the Glycemic
Optimization with Algorithms and Labs At Point
of Care study group.
Prior to small- and large-fibre monofilament
screening, physician perception of whether the
patients had neuropathy was assessed using a short
survey.
Each monofilament was then applied to the pump
of the great toe on one foot to determine if neuropathy
or insensate foot was present. With their eyes
closed, patients were asked to indicate when and
where a monofilament touch occurred.
Overall, monofilament testing showed that 63%
of patients did not have neuropathy, 30% had non-severe
neuropathy, and 7% had severe neuropathy.
Patients with more severe neuropathy tended to
be taller and older, have a longer duration of
diabetes and have slightly higher fasting plasma
glucose levels on the day of testing, the study
showed.
As the severity of neuropathy increased, so too
did feelings of pins and needles. These patients
were also more likely to have foot ulcers and
require custom footwear, Dr. Herman reported.
The vast majority of patients without neuropathy
(92.4%) were identified correctly by treating
physicians. But when it came to patients with
neuropathy, physician perception was inaccurate
regardless of specialty, with 64.4% of endocrinologists
and 69.3% of primary-care physicians missing a
diagnosis of non-severe neuropathy, Dr. Herman
said.
About 1 in 4 endocrinologists missed a diagnosis
of severe neuropathy, compared with about one
in 3 primary-care physicians.
Noting that the findings suggest that many cases
of early neuropathy may go undetected until serious
complications such as foot ulcers arise, the researchers
called for routine testing for the presence of
neuropathy on a regular basis.
[Study title: Physician Perception of Neuropathy
in a Large Type 2 Diabetes Population (GOAL A1C
Study) Confirms Underdiagnosis of Neuropathy in
Everyday Clinical Practice.]
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