Underdiagnosis of Peripheral Neuropathy in Type 2 Diabetes

Abstract

Diabetic peripheral neuropathy and its late sequelae cost >$4 billion annually in the U.S. (1). Improved glycemic control, early detection, and preventive care can prevent or delay adverse outcomes (2–4). An annual foot exam, which may include monofilament testing, is recommended by the American Diabetes Association (5). Unfortunately, neuropathy screening is underutilized in primary care practice (6,7). The GOAL A1C (Glycemic Optimization with Algorithms and Labs At Po1nt of Care) study assessed methods of A1C testing and insulin titration monitoring strategies in a large nationwide sample of predominantly primary care patients with type 2 diabetes. At baseline, physician perception of the presence of neuropathy was assessed via a survey before monofilament testing. A comparison between physician perception and monofilament testing is reported. GOAL A1C was a randomized, open-label, parallel, four-arm study that compared the impact of point of care versus laboratory A1C testing and weekly versus less frequent insulin titration monitoring on glycemic control in patients with type 2 diabetes adding insulin glargine to existing oral antidiabetic therapy. Eligible patients were aged ≥18 years, inadequately controlled on oral antidiabetic agents (A1C >7.0%), and candidates for insulin. All signed informed consent …