“Painful distal sensory polyneuropathy (DSPN) is associated with considerable morbidity and an increased risk of mortality, although neuropathy screening is under-utilised in primary care practice,” explained Prof. Dr. Dan Ziegler, Deputy Director of the Institute for Clinical Diabetology of the German Diabetes Centre at Heinrich Heine University in Düsseldorf. The fact that DSPN is often diagnosed very late in spite of its serious consequences is also confirmed by the results of the PROTECT Study, the latest evaluation1 of which was presented by Prof. Ziegler at NEURODIAB*. Data was analysed from 1,589 study participants who underwent a foot examination which included bilateral assessment of vibration, pressure, and temperature perception and palpation of the pedal pulse as part of a nationwide educational initiative on diabetic neuropathy in Germany. This brought to light a staggering number of previously undiagnosed neuropathies: approximately every other diabetic individual examined was found to have distal symmetrical polyneuropathy. Although around two-thirds of them were even suffering from symptoms such as pain and a burning sensation in their feet, a large proportion of them did not know that they were affected by neuropathy: for example, 60 % of the study participants with known type 2 diabetes and painful neuropathy had stated before the examination that they had never been diagnosed with neuropathy. Among participants in whom nerve damage manifested itself not in the form of pain, but as paraesthesias, numbness or the absence of symptoms, the proportion of previously undiagnosed cases was even 20 % higher.
Even among the study participants who stated that they did not have diabetes (ND), almost every second individual showed indications of neuropathy. In many cases, previously undiagnosed (pre-)diabetes could be the cause, said Ziegler, as one-third of the ND group displayed an increased diabetes risk with HbA1c values of above 5.7 %. The expert therefore called for “the implementation of effective strategies to reveal both undetected diabetes and neuropathy”.