Effective Neuropathy Screening Tool Often Overlooked

Neuropathy, or nerve damage, is one of the most common diabetic complications, affecting up to 70% of people who have diabetes. Now, new research from the University of Michigan shows that many people with the condition are receiving a less effective — and more expensive — test to diagnose the condition, instead of a more accurate diagnostic test.

In people who have diabetes, neuropathy is believed to be caused in large part by excess glucose in the blood infiltrating the nerves and interfering with their electrical signals. Sensory neuropathy impacts the nerves responsible for sensation, and typically affects the feet, legs, hands, and arms. Symptoms include pain, numbness, loss of sensation, tingling, coldness, and sensitivity to touch. (Another type of neuropathy, autonomic neuropathy, impacts nerves that control the functions of internal organs, and may cause complications ranging from gastroparesis to sexual dysfunction.)

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Along with diabetes, other causes of neuropathy include shingles, vitamin deficiency (particularly of vitamin B12), autoimmune diseases such as lupus and rheumatoid arthritis, exposure to toxins, use of certain cancer medicines, and more. Diabetes is the most common cause of peripheral neuropathy, or neuropathy that affects the arms, legs, hands, and feet.

In an effort to make diagnosis of peripheral neuropathy more efficient, researchers used the 1996–2007 Health and Retirement Study to determine how this condition is typically diagnosed. They identified 1,031 people who had been diagnosed with neuropathy and met the study’s criteria. The researchers then focused on 15 diagnostic tests for the condition, studying the pattern of testing six months before and after the participants’ diagnoses.

The researchers found that the low-cost glucose tolerance test — the test measures a person’s blood glucose response to the consumption of a glucose-rich drink after at least eight hours without food or drink — which could detect undiagnosed diabetes in people experiencing neuropathy symptoms, was ordered in only 1.0% of people. Expensive magnetic resonance imaging, or MRI, tests of the spine or brain (which cannot identify diabetes), on the other hand, were ordered in 23.2% of people.

“Our findings, that MRIs were frequently ordered by physicians, but a lower-cost glucose tolerance test was rarely ordered, show that there is substantial opportunity to improve efficiency in the evaluation of peripheral neuropathy,” noted lead researcher Brian Callaghan, MD. “Currently no standard approach to the evaluation of peripheral neuropathy exists. We need more research to determine an optimal approach. We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

For more information, read the article “Neuropathy Patients More Likely to Receive High-Cost, Low-Yield Screening Instead of More Effective Tests” or see the study’s abstract in the Archives of Internal Medicine. And to learn more about controlling pain from neuropathy, see the articles “Coping With Painful Neuropathy” and “Controlling Neuropathic Pain.”

  • calgarydiabetic

    Makes sense to do the obvious first. Actually the Doctors should do a finger prick. If the sugar is high enough for nerve damage it should show up on even the inaccurate 5 second meters that we all now enjoy.

  • John_C

    I thought the best part of the article was the quota:

    “We do a lot of tests that cost a lot of money, and there’s no agreement on what we’re doing.”

    Keeping blood sugar under best control is obviously the answer — this is not new science. Those who do this have even experienced decreased neuropathy.

  • marylittle

    thank you for bringing up autonomic neuropathy for sure as there is little you can really find about it and to most people it’s just another word..their are those of us out there scared to death almost trying to live with the results of this and not knowing what to do except wait for sure and keep the diabetes under control..it’s hard when you lose the ability to ‘feel’ the drops in blood sugars and haver no symptoms at all
    again thanks

    oh and by the way calgarydiabetic my meter is accurate with the doc plus or minus 5 points and it is the same with the blood draw..are you cleaning the fingers with warm soap and water???
    :)

  • Gardengirl

    My overnight fasting test was normal.
    Not until I had a glucose tolerance test and an A1c test did I learn I was diabetic and that high blood sugar had caused my neuropathy.

  • Indy Guy

    Another example of lawyers running the country. Doctors are giving the MRI so that they can’t be sued for missing a brain or spine disease.
    If they find high glucose levels, let the person know they have diabetes, and that with 99% certainty that is the cause of the neuropathy, there is still a 1% chance it’s something else also (or instead), and the doc could get sued for missing a spine or brain problem.
    Have you ever heard a doc be sued for missing a diabetes diagnosis for a few months?

  • John A

    I’ve found that a heating pad rolled in a towel or small throw to avoid over heating and placed at the foot of the bed under the covers has reduced the numbness in my toes and the ball of my foot. Anecdotal, but cheap to try. It works for me. I’m type II 12 years

  • Becky

    I had numbness in my left leg. I underwent several expensive tests, MRI included. There was not a determined cause. A few years later, I was diagnosed with diabetes. If I had had a glucose tolerance test, I would have been diagnosed sooner. However, the numbness went away because I have tightly controlled my blood sugar since diagnosis. I did have 3 toes go numb since then, but that went away when I quit taking statins. I don’t know if that is a coincidence or not.