Diabetic neuropathy: the cost of late diagnosis
Diabetic neuropathy exacts a heavy toll on the health and wellbeing of people with diabetes – and the health services that care for them. So why aren’t we finding cases earlier, when there’s still time to prevent the worst of the damage? Professor Solomon Tesfaye’s new module gets to the nub of the matter with an in-depth look at screening and diagnosis.
As Professor Solomon Tesfaye makes clear at the start of his module, ‘Screening and diagnosis of painful diabetic neuropathy’, diabetic neuropathy is not a single disease but a combination of a number of disorders. The category encompasses syndromes involving single nerves or groups of nerves (usually on one side of the body), such as ptosis, focal abdominal neuropathy, carpal tunnel syndrome or diabetic amyotrophy. There are the autonomic neuropathies too – gastroparesis, gustatory sweating, etc. His main focus here, however, is on painful peripheral diabetic neuropathy (DPN).
Solomon is Professor of Diabetic Medicine at University of Sheffield, UK, and Consultant Endocrinologist at Sheffield’s Hallamshire Hospital. He is also a former chairman of NEURODIAB and of the International Expert Group on Diabetic Neuropathy. And after several decades working in the field, he is no stranger to the profound impact neuropathy has on the lives of people with diabetes. The costs to health services are stark enough (£1 billion spent annually on diabetic foot complications in the UK alone). The personal costs for people with diabetes themselves – the psychosocial consequences (anxiety, depression, isolation, job loss, etc.) as well as the huge toll in terms of increased mortality and the burden of living with chronic pain: these are almost incalculable.
Today’s rising tide of amputation is driven by late detection of DPN. What’s needed is a better approach to screening and diagnosis. Solomon’s module gives some clear pointers as to where things might be improved. Take the 10 g monofilament – currently the gold standard for screening. While this is a good indicator for foot ulceration risk, says Solomon, it’s not a good indicator of DPN. “By the time DPN is picked up using monofilament, the neuropathy is too advanced and is irreversible.”
This insightful module sets out clearly the reasons why better screening and diagnosis are so urgently required - and proposes several ways in which we might do things differently and better (e.g. use of innovations in diagnostics, one-stop screening clinics). And its packed with case studies and clinical scenarios aimed to help you plan your own approach to the screening, clinical examination and diagnosis of painful diabetic neuropathy in people with type 1 and type 2 diabetes.
Watch out for Professor Tesfaye’s podcast, the latest in our series ‘The patient who changed the way I think about diabetes’ – posting on Thursday this week.