Screening

Screening for peripheral neuropathy

Screening for peripheral neuropathy should be undertaken in patients with:[1]​​[34]​​​

  • Type 2 diabetes, from diagnosis

  • Type 1 diabetes, from 5 years after diagnosis

  • Metabolic syndrome or impaired glucose tolerance with symptoms of peripheral neuropathy.

Screening should be conducted at least annually thereafter, using symptoms and signs. Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation (small-fibre function) and vibration sensation using a 128-Hz tuning fork (large-fibre function). All people with diabetes should have annual 10-g monofilament testing to identify feet at risk for ulceration and amputation. Foot evaluation should also include vascular assessment and inspection of the skin. Patients with evidence of sensory loss or prior ulceration or amputation should have their feet inspected at every visit.​[34][Figure caption and citation for the preceding image starts]: Vibratory testingCreated by the BMJ Group [Citation ends].com.bmj.content.model.Caption@5e63187d[Figure caption and citation for the preceding image starts]: Light touch testing with monofilamentCreated by the BMJ Group [Citation ends].com.bmj.content.model.Caption@227ea1a7

The Michigan Neuropathy Screening Instrument (MNSI) and similar symptom scoring systems are useful in clinical research.[109][110][111][112]

Electrophysiological testing or referral to a neurologist is rarely needed, except in situations where diagnosis is unclear or the clinical features are atypical, for example:[1]​​[34]​​

  • Motor deficits greater than sensory deficits

  • Marked asymmetry of neurological deficits

  • Initial symptoms in the upper extremities

  • Rapid progression.

Screening for autonomic neuropathy

The American Diabetes Association (ADA) recommends evaluating individuals with diabetes for signs and symptoms of autonomic neuropathy at the following intervals:[34]

  • Type 2 diabetes, from diagnosis

  • Type 1 diabetes, from 5 years after diagnosis

  • Diabetes of any type, annually thereafter

  • When there is evidence of other microvascular complications (e.g., diabetic kidney disease or diabetic peripheral neuropathy)

Screening may involve questions about orthostatic dizziness, syncope, or dry, cracked skin of the extremities. Clinical signs can include orthostatic hypotension, resting tachycardia, and peripheral skin changes.​[34]

In routine practice, further diagnostic testing is often unnecessary if it does not alter management or outcomes. However, the ADA suggests that additional testing may be considered in symptomatic individuals, depending on the organ system involved. This may include cardiovascular autonomic testing, sudomotor function assessment, urodynamic studies, gastric emptying tests, or endoscopy/colonoscopy.[34]

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