Diabetic Neuropathy Screening Guidelines

Screening Recommendations

The American Diabetes Association recommends screening all patients with type 2 diabetes at diagnosis and type 1 diabetes patients 5 years after diagnosis, then annually thereafter, using a 10-g monofilament test combined with at least one additional neurological assessment tool 1, 2, 3
The screening examination must include a combination of tests such as pinprick sensation, temperature perception, vibration perception, and 10-g monofilament testing to assess both small and large fiber function 1, 2, 3, 4

Loss of protective sensation (LOPS) is confirmed when there is absent 10-g monofilament sensation and one other abnormal neurological test, which identifies feet at highest risk for ulceration and amputation 1, 2, 3, 5

A detailed history should be taken to document diabetes control, smoking, exercise tolerance, claudication, rest pain, prior ulcerations or amputations 3, 5
The examination should include a skin integrity assessment, vascular examination, and structural assessment to identify risk factors for ulceration 3, 5

Patients with microvascular complications should be assessed for autonomic symptoms such as hypoglycemia unawareness, resting tachycardia or orthostatic hypotension, gastroparesis, constipation, diarrhea, fecal incontinence, erectile dysfunction, neurogenic bladder, and abnormal sweating patterns 1, 2, 4

Up to 50% of diabetic peripheral neuropathy is asymptomatic, so symptoms should not be relied upon solely for diagnosis 2, 6
The 10-g monofilament test should not be skipped as it is the single most sensitive test for identifying ulceration risk 3, 5