Screening

There are many important physical examination components to consider in the evaluation of a patient with diabetes. According to the American Diabetes Association 2016 Standards of Medical Care in Diabetes,11 patients with type 2 diabetes should undergo screening for peripheral neuropathy at the time of diagnosis, and patients with type 1 diabetes should be screened 5 years after diagnosis. Following the initial screening, all patients with diabetes should be monitored on an annual basis for this condition. Screening should focus on sensory function, including pinprick, temperature, and vibratory perception (128-Hz tuning fork), or pressure sensation (10-g monofilament at distal halluces).12 Two simple screening tests, including the Michigan neuropathy screening instrument and the United Kingdom screening test, are available for routine clinical practice.13 Patients with diabetes should be educated regarding the importance of vigilant examination and care of their lower extremities. They should be taught to perform daily foot checks and note the development of calluses, ulcers, or deformation. Proper footwear, including socks, should be reviewed in an effort to prevent calluses or ulcers. Additionally, these patients should be taught about proper toenail trimming and dry skin management. Referral to a podiatrist should be considered if lower-extremity deformities are present or if assistance with toenail trimming is needed.

Diagnosis

A diagnosis of diabetic peripheral neuropathy is commonly considered on the basis of a patient’s presenting signs and symptoms, medical history, and physical examination findings. A diagnosis of diabetic peripheral neuropathy can be confirmed after electrodiagnostic, sensory, and autonomic function testing. Diagnostic tests commonly performed during an evaluation for diabetic peripheral neuropathy are summarized in Table 4.


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This article originally appeared on Clinical Advisor