Detection of diabetic peripheral neuropathy: Strategies for screening and diagnosis

Diabetes is a devastating disease that affects every part of the body, with complications both microvascular and macrovascular in nature. Examining microvascular disease (the foot in particular), statistics reveal that infected foot wounds commonly progress, with at least half of all infections of the lower extremity resulting in ulceration and a disturbing 1 in 5 of these events leading to lower-extremity amputation. Half of all patients who undergo amputation die within 3 years. This is tantamount in terms of morbidity and mortality to a high-grade carcinoma, yet even when patients are admitted to the hospital for a diabetic foot complication, they are frequently evaluated in a manner that is less than adequate. It is vital that clinicians identify and stratify risk among their patients with diabetes. Specifically, to determine ulcer risk, healthcare practitioners should determine whether there is loss of protective sensation, whether the patient has a deformity that results in high pressure to certain areas of the foot, and whether there is a prior history of ulcers and amputations. The diagnosis of diabetic peripheral neuropathy and the subsequent assessment of ulcer risk can only be made via careful and (at least) annual clinical examination.