Historical Background
In the U.S., diabetes and diabetic neuropathy affect all races and ethnicities disproportionately. Numerous studies suggest that American populations have a greater prevalence of diabetic neuropathy than other ethnic or racial groups. Socioeconomic factors, healthcare availability, genetics, and lifestyle choices contribute to this disparity. Income and education are the main barriers to diabetes and its consequences in treatment for people with low incomes (Hassan et al., 2023). Diabetic neuropathy also affects America due to health care access and quality inequalities. Diabetes problems like neuropathy might occur in poor persons due to delayed diagnosis or inadequate treatment due to limited healthcare access. Rural healthcare provider shortages and transportation barriers exacerbate diabetes treatment disparities (Hill-Briggs et al., 2022). Diabetic neuropathy gaps are partly genetic, and some populations are more prone to neuropathy. Food, exercise, and drug use lead to rising blood sugar levels and neuropathy (Strath et al., 2022).
To avoid these inequalities, multilevel techniques that assess biological, social, and ecological aspects are needed. To eliminate diabetes neuropathy in America and low-income neighborhoods, healthcare access and quality must be prioritized. It involves funding community health centers, health insurance, and health equity. Obesity, sedentary lifestyle, and poor diet can avoid diabetes neuropathy. To reduce the burden of care and improve diabetic care inequality, healthcare staff and the public must be informed about early diagnosis and management of diabetes complications, including neuropathy (Hill-Briggs et al., 2022). Diabetic neuropathy, a frequent ailment among Americans of all races and ethnicities, has no one remedy that must take into account social, environmental, and biological aspects. Improving care access, quality, health equality, and controllable risk factors can reduce diabetic neuropathy and improve outcomes for all U.S. diabetics. The current actions are substantial, but more must be done to close the gap and provide the same healthcare to all diabetics and their complications.
Previous Studies
Michigan Neuropathy Screening Instrument (MNSI)
Many diabetic neuropathy symptoms and signs are assessed using Michigan’s 1990 MNSI. Neuropathy symptoms and manifestations are assessed using the 15-item self-administered MNSI questionnaire and physical exam (TODAY Study Group, 2022; Nkonge et al., 2023). The touch-based screening method Semmes-Weinstein Monofilament (SWM) could diagnose neuropathy (Raymond et al., 2020). Neural conduction studies (NCS) examine nerve electrical signal speed and strength to validate neuropathy diagnosis (O’Bryan & Kincaid, 2021). The Norfolk Quality of Life Diabetic Neuropathy (QOL-DN) questionnaire, Ipswich touch test, and Neuropathy disability score are used in some research beyond screening. This investigation emphasizes the need of employing multi-factorial tests to detect and monitor diabetes neuropathy early to prevent or delay severe effects.
Semmes-Weinstein Monofilament (SWM)
Diabetes patients test their touch with affordable and convenient Semmes-Weinstein monofilament (SWM). It aids nerve injury diagnosis. Raymund et al. (2020) found that soft-tissue massage helps identify diabetic neuropathy. Vibrational therapy is more effective than other SWM for exploring lower extremity feelings. The WMM was tailored to detect wounded tissues using tactile signaling and neuropathic sensory sensitization. Its simplicity and directness make it ideal for primary and diabetes care checks. Diagnose Diabetic Neuropathy with SWM to detect early nerve failing fiber process and treat to prevent progression. Thus, availability and affordability of these laboratory services aim to help low-cost health divisions like the SWM that lack diagnostic capabilities. For early diabetic neuropathy detection, the SWM is a frontline tool. Early detection lets diabetics temporarily prevent or reduce neuropathy.
Nerve Conduction Studies (NCS)
NCS monitors nerve signal speed and strength to diagnose neuropathy (O’Bryan & Kincaid, 2021). General neuropathy diseases are usually diagnosed with NCS screening, although African Americans are not excluded. Neuron conduction test abnormalities and their clinical importance were thoroughly reviewed by O’Bryan and Kincaid (2021). NCS helps clinicians diagnose and characterize neuropathic diseases by measuring nerve conduction speeds and amplitudes. Regardless of race or ethnicity, NCS is a non-invasive, universal examination. NCSs are the most prevalent pathological nervous system diagnostic tools and are safe and flexible regardless of age, gender, or ethnicity. An advanced algorithm improves NCS diagnosis and targets nerve damage for early treatment. Health disorders like neuropathy are non-racial, but NCS are the main instruments for detection and treatment.
Other Tools
Clinical and research methods have been used to diagnose diabetic neuropathy. The Norfolk Quality of Life Diagnostic Neuropathy (QOL-DN) questionnaire, validated by Brown et al. (2021), measures how neurological illnesses impair patients’ quality of life. With the quiz, neuropathy’s physical, emotional, and social elements can be assessed; this aids therapists with therapeutic customization. According to Zhao et al. (2021), the Ipswich Touch exam is a simple but effective diabetic peripheral neuropathy exam. The tactile sensation evaluation instrument speeds up neuropathy diagnosis, allowing early sculpture treatment. The Neuropathy Disability Score (NDS) defines neuropathy severity and everyday life impact, per Zhao et al. (2021). NDS examines sensory, motor, and autonomic nerve systems to assist doctors diagnose and treat diseases based on severity.
People with diabetes undergo nerve function and integrity testing and surveys. Babitha and Subathra (2020) measured patients’ vibratory stimuli perception to assess sensory neuropathy. Diabetic neuropathy’s destructive potential is discovered before it occurs. As Reimer and others indicated, the Medoc TSAII quantitative sensory testing instrument comprehensively analyzes heat sensitivity to detect and diagnose sensory neuropathy. The technology evaluates heat provocation experience to help doctors diagnose neuropathy. Increased diagnosis sensitivity leads to tailored therapy and improved results.
Diabetic neuropathy impairs sudomotor function, which Sudoscan and Neuropad tests objectively assess. Burgess et al. (2021) describe Sudoscan equipment, which tracks sweat gland activity using electrochemical skin conductance to diagnose autonomic neuropathy. The Neuropad test rapidly screens for autonomic neuropathy in clinical settings using colorimetry, according to Carmichael et al. (2021). These examinations assess diabetic neuropathy patients’ nerve function and integrity with sensory and motor evaluations.
Corneal confocal microscopy and skin biopsies show structural changes in diabetic neuropathy. For early neuropathy diagnosis and monitoring, Carmichael et al. (2021) demonstrated that corneal confocal microscopy can view corneal nerve fibers non-invasively. As revealed by Carmichael et al. (2021), skin biopsy permits histological examination of epidermal nerve fiber density and shape. Imaging technologies enable us to diagnose diabetic neuropathy and develop personalized treatments to improve patient outcomes.
Kamiya et al. (2021) revealed that the DPNcheck device can examine lower leg sural nerve conduction, along with conventional diabetic neuropathy testing tools. Point-of-care nerve function testing with this tool helps clinicians assess diabetic peripheral nerve integrity. By evaluating sural nerve conduction velocities and amplitudes, the DPNcheck device detects and classifies neuropathy early, enabling earlier nerve damage prevention treatments. The DPNcheck device helps doctors swiftly identify at-risk neuropathy patients and start therapy. Finally, each diabetic neuropathy testing and diagnosis approach has its own merits and insights. Objective measures and advanced imaging can increase neuropathy diagnosis accuracy and precision in clinical practice, which helps people with diabetes receive timely care and tailored strategies. Research and technology are also improving diabetic neuropathy diagnosis and treatment, boosting results and quality of life.
Theoretical Framework
Diabetic neuropathy is complicated; hence, bio-psychosocial paradigms are applied in research. This paradigm acknowledges that genetics and physiology predispose to neuropathy (Rogers, 2021). Diabetics’ glucose metabolism and vascular health cause nerve damage and dysfunction, while heredity may alter neuropathy susceptibility. Understanding neuropathic symptom management needs psychological factors, including symptom perception and coping. Symptom perceptions affect healthcare-seeking and treatment adherence. Coping with neuropathic symptoms can also influence quality of life. The biopsychosocial model is complete for investigating diabetic neuropathy’s causes and effects due to its biological and psychological components.
Societal health factors also affect American diabetic neuropathy. Neuropathy diagnosis, treatment, and management depend on socioeconomic position and healthcare availability (Rogers, 2021). Healthcare access and quality disparities affect neuropathy prevalence and outcomes, especially in marginalized and underserved groups. Diabetes management and neuropathy consequences depend on income, education, and housing. These social determinants of health must be addressed for holistic and equitable neuropathy prevention and management.
Along with the bio-psychosocial paradigm, the Health Belief paradigm and Social Cognitive Theory assist diabetic neuropathy screening and care (Smith et al., 2020). The Health Belief Model states that health condition susceptibility, severity, benefits, and drawbacks influence health behaviors. The strategy aims to enhance diabetic neuropathy patients’ awareness of their risk of neuropathy-related problems to assist them in seeking early diagnosis and treatment and remove perceived barriers to care. Health is affected by self-efficacy, result expectations, and social support, according to Social Cognition. This theory may help neuropathy-afflicted diabetics manage their issues and make healthcare decisions by offering them knowledge, skills, and resources. Theoretical frameworks allow diabetic neuropathy treatment to be customized, improving health and quality of life.
Related Studies
Some significant characteristics of Inflows 60-second diabetic screening tool to avoid diabetic foot ulceration and amputation are studied in diverse patients. Inflows 60-minute diabetic screening tool accuracy and effectiveness are examined, as with Patel et al. 2022. This essential inquiry will test how quickly the instrument can identify diabetic patients’ neuropathy risk. Diabetics and others who check their blood sugar regularly need trustworthy and precise equipment; this can be done through research and trials in diabetic-heavy countries. This study identified patients at risk of diabetic foot ulceration and amputation and developed risk-reduction methods. Researching glycemic control, foot care, and comorbidities would help researchers adapt treatment. Therapeutic interventions may include changing diet, foot care, and education. By addressing these risk factors and others, doctors can avoid diabetic complications and improve diabetic health.
This research focuses on early detection and prevention of diabetic complications in various patient populations. Preventing diabetic foot ulceration and amputation requires periodic foot exams, patient education, and lifestyle adjustments. Community engagement and cultural awareness are critical to these methods. Integrating community stakeholders and tailoring programs to diverse patient cultures and social situations can boost trust, involvement, and prevention. Diabetic neuropathy worries all patients, especially those who disproportionately have diabetes. The Inflows 60-second diabetic screening test may enhance early detection and treatment. Research, collaboration, and evidence-based therapy tailored to diabetes patients’ needs are needed to reduce health disparities and promote equity. Working collaboratively, doctors and researchers can reduce diabetic complications and improve the quality of life for all patients.
Methodological Framework
Different methods have been used to study diabetes screening instruments and therapy. These studies have large samples, improving statistical power and generalizability. Several longitudinal studies tracked diabetic neuropathy and therapeutic efficacy. Neuropathy and its causes are fully understood using multi-modal examinations, including screening. However, this research needs to be revised. For symptom reporting and treatment adherence, self-report evaluations can introduce bias and mistakes. Studies with homogenous populations are rarely generalizable. Study samples may not be typical of patient populations, emphasizing the need for diverse demographic groupings in research.
To solve these problems and advance the discipline, future research should use randomized controlled trials. RCTs reduce bias and confounding variables for intervention efficacy by randomly assigning participants to treatment and control groups. Researchers can utilize RCTs to find causal linkages between medicines and outcomes for evidence-based clinical decision-making. Study groups should be diverse to enhance generalizability and usefulness across patient backgrounds. RCTs and diverse and inclusive study designs will improve diabetic neuropathy screening and treatment, improving patient care and outcomes.
Conclusion
Finally, diabetic neuropathy affects all individuals, underscoring the necessity for widespread screening and treatment. The Inflows 60-second diabetic screening tool is culturally sensitive and successful, helping people with diabetes diagnose and prevent issues like diabetic foot ulceration and amputation, enhancing their quality of life. These screening methods immediately identify neuropathy risk, enabling early diagnosis and treatment to limit disease progression and avoid morbidity. Diabetic neuropathy is complex and requires more than screening. Patient-specific therapies should improve glucose control, promote healthy lifestyle choices, including exercise and balanced nutrition, and provide proper foot care. Patients can actively participate in their care and recognize neuropathy early with patient education, enabling timely intervention and therapy. Understanding diabetic neuropathy and developing screening and therapeutic approaches requires research and innovation. New technology can be used to study early identification, risk stratification, and individualized care to reduce diabetic neuropathy and enhance diabetic health.
References
Babitha, R., & Subathra, T. A. (2020). The Semmes-Weinstein monofilament examination as a single effective screening tool in diagnosing diabetic peripheral neuropathy when compared to vibration perception threshold. National Journal of Physiology, Pharmacy and Pharmacology, 10(5), 419–419.
Brown, J. J., Colberg, S. R., Pribesh, S., Baskette, K. G., & Vinik, A. I. (2021). A Comparison of Neuropathy Quality of Life Tools: Norfolk QOL-DN, PN-QOL-97, and NeuroQOL-28. Medical Research Archives, 9(11).
Burgess, J., Frank, B., Marshall, A., Khalil, R. S., Ponirakis, G., Petropoulos, I. N., & Alam, U. (2021). Early detection of diabetic peripheral neuropathy: a focus on small nerve fibres. Diagnostics, 11(2), 165.
Carmichael, J., Fadavi, H., Ishibashi, F., Shore, A. C., & Tavakoli, M. (2021). Advances in screening, early diagnosis, and accurate staging of diabetic neuropathy. Frontiers in Endocrinology, 12, 671257.
Hassan, S., Gujral, U. P., Quarells, R. C., Rhodes, E. C., Shah, M. K., Obi, J., … & Narayan, K. V. (2023). Disparities in diabetes prevalence and management by race and ethnicity in the USA: defining a path forward. The Lancet Diabetes & Endocrinology.
Hill-Briggs, F., Ephraim, P. L., Vrany, E. A., Davidson, K. W., Pekmezaris, R., Salas-Lopez, D., … & Gary-Webb, T. L. (2022). Social determinants of health, race, and diabetes population health improvement: Black/African Americans as a population exemplar. Current diabetes reports, 22(3), 117–128.
Kamiya, H., Shibata, Y., Himeno, T., Tani, H., Nakayama, T., Murotani, K., & Nakamura, J. (2021). Point‐of‐care nerve conduction device predicts the severity of diabetic polyneuropathy: a quantitative but easy‐to‐use prediction model. Journal of Diabetes Investigation, 12(4), 583-591.
Nkonge, K. M., Nkonge, D. K., & Nkonge, T. N. (2023). Screening for diabetic peripheral neuropathy in resource-limited settings. Diabetology & Metabolic Syndrome, 15(1), 1-11.
O’Bryan, R., & Kincaid, J. (2021). Nerve conduction studies: basic concepts and patterns of abnormalities. Neurologic Clinics, 39(4), 897–917.
Patel, R., Patel, C., Patel, M., Patel, M., Parmar, R., Parmar, V., & Das, M. N. (2022). A Study To Assess The Effectiveness Of Burger Allen Exercise On Improving Peripheral Circulation Among Type 2 Diabetes Mellitus Patients In Selected Hospitals Of Nadiad, Gujarat. Journal of Pharmaceutical Negative Results, 2390-2398.
Raymond, B., Steriovski, J., Gillyard, K., Yang, C., Wu, S. C., & Crews, R. T. (2020). Choosing a vibratory test to pair with Semmes Weinstein monofilament testing for evaluating lower extremity sensation in patients with diabetes: a comparison of three vibratory methodologies. Journal of diabetes science and technology, 14(1), 8–15.
Reimer, M., Forstenpointner, J., Hartmann, A., Otto, J. C., Vollert, J., Gierthmühlen, J., & Baron, R. (2020). Sensory bedside testing: a simple stratification approach for sensory phenotyping. Pain Reports, 5(3).
Rogers, C. K. (2021). Understanding Older Adults Living in Medically Underserved Areas Perspectives Regarding Type 2 Diabetes Care Received (Doctoral dissertation, Seton Hall University).
Smith, Y., Garcia-Torres, R., Coughlin, S. S., Ling, J., Marin, T., Su, S., & Young, L. (2020). Effectiveness of social cognitive theory–based interventions for glycemic control in adults with type 2 diabetes mellitus: protocol for a systematic review and meta-analysis. JMIR research protocols, 9(9), e17148.
Strath, L. J., & Sorge, R. E. (2022). Racial differences in pain, nutrition, and oxidative stress. Pain and Therapy, 11(1), 37-56.
Zhao, N., Xu, J., Zhou, Q., Li, X., Chen, J., Zhou, J., & Liang, J. (2021). Application of the Ipswich Touch Test for diabetic peripheral neuropathy screening: a systematic review and meta-analysis. BMJ open, 11(10), e046966.
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