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Make the Diagnosis: Diabetic Peripheral Neuropathy

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Prior Probability of Large-Fiber Peripheral Neuropathy in Diabetes

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The highest quality studies show a prevalence of 39%-77% of large-fiber peripheral neuropathy in patients with Type 2 diabetes.1, 2

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Population in Whom Large-Fiber Peripheral Neuropathy Should Be Suspected

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Because of its high prevalence and because some patients have an insensate foot without symptoms, annual screening for large-fiber peripheral neuropathy among patients with diabetes is recommended.

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Physical and Neurological Examination and Screening

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Examination should include physical assessment of the legs and feet and neurological examination. Symptoms that should prompt an examination include tingling, numbness, or a sensation of heaviness in the hands or legs; burning, stabbing pain, or cramps in the arms or legs; a sensation that the walking surface feels unusual or that the patient has trouble perceiving uneven surfaces; experiencing trauma to the skin of the feet without pain; or weakness in the legs while climbing stairs. The clinician must recognize that patients with diabetes can have neuropathy for reasons unrelated to their diabetes, so the symptoms of neuropathy require a review of conditions that can cause peripheral neuropathy.

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Useful findings for detecting diabetic large-fiber neuropathy are shown in Table 77-1. While a positive result on the Symptoms of Neuropathy screening questionnaire (Box 77-1) identifies patients more likely to have large-fiber neuropathy (LR, 4.0; 95% CI, 2.9-5.6) and a negative result identifies patients less likely to have large-fiber neuropathy (LR, 0.19; 95% CI, 0.10-0.38), the physical examination findings perform better.

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Table Graphic Jump Location
Table 77-1Useful Findings for Detecting Diabetic Large-Fiber Neuropathy
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Table Graphic Jump Location
Box 77-1Questionnaire on Symptoms of Neuropathy (Italian Society of Diabetology)3,a

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