New diagnostic tests for diabetic distal symmetric polyneuropathy☆
Received 22 July 2009; received in revised form 13 September 2009; accepted 28 September 2009. published online 09 November 2009. Corrected Proof
Abstract
Neuropathy needs to be diagnosed early to prevent complications, such as neuropathic pain or the diabetic foot. It is obvious that diagnosis of neuropathy needs to be improved. New peripheral nerve function tests that appear to facilitate diagnosis are now emerging. This review outlines the new tests that have been proposed for the diagnosis of diabetic distal symmetric polyneuropathy, the commonest form of neuropathy in diabetes. New tests are classified into those mainly assessing large-fiber function (tactile circumferential discriminator, steel ball-bearing, and automated nerve conduction study) and those mainly assessing small-fiber function (NeuroQuick and Neuropad). Emerging tests are promising but must be evaluated in prospective studies. Moreover, their cost-effectiveness needs more careful appraisal. The clinician should, therefore, still rely on established modalities to diagnose neuropathy, but wider use of the new tests is expected in the near future.
aOutpatient Clinic of the Diabetic Foot in the Second Department of Internal Medicine at Democritus University of Thrace, Greece
bInstitute for Clinical Diabetology, German Diabetes Center at the Heinrich Heine University, Leibniz Center for Diabetes Research and Department of Metabolic Diseases, University Hospital, Düsseldorf, Germany
Corresponding author. Democritus University of Thrace, 68100 Alexandroupolis, Greece. Tel.: +30 6977 544337; fax: +30 25510 74723.
☆ Conflicts of interest: Both authors have received honoraria for participation in advisory board meetings of Miro, the manufacturer of Neuropad. D.Z. was also a co-owner of a patent on the NeuroQuick.
ABSTRACT