Diabetic peripheral neuropathy (DPN) is one of the most common complications of diabetes, yet its diagnosis can be deceptively complex. As a diagnosis of exclusion, DPN requires careful consideration of other potential causes of neuropathy to avoid misdiagnosis and delayed treatment.1 The American Diabetes Association currently recommends that all patients with type 1 diabetes diagnosed five or more years ago, as well as all patients with type 2 diabetes, should be assessed annually for DPN.1 There are multiple noninvasive clinical tests available for screening, including a pinprick test and vibration perception thershold.1,2 New onset or rapidly progressing symptoms warrant further investigation.
Differentiating Peripheral Neuropathies
Many conditions can mimic the symptoms of DPN, including vitamin B12 deficiency, hypothyroidism, alcohol-related neuropathy, and autoimmune diseases like Sjögren’s syndrome.3 Additionally, medications such as chemotherapy agents and certain antiretrovirals can cause neuropathic symptoms, necessitating a detailed patient medication history review.1 Most cases of DPN can be diagnosed with simple clinical tools, like a thorough history and comprehensive foot exam with monofilament testing. Electrodiagnostic studies, such as nerve conduction tests, can differentiate DPN from other neuropathies when the diagnosis is unclear.
Risks of Delayed or Missed Diagnosis
Failing to rule out other causes of neuropathy may lead to inappropriate treatment and progression of underlying conditions. For example, undiagnosed vitamin B12 deficiency can result in irreversible neurological damage. The American Diabetes Association emphasizes the need for comprehensive evaluation, particularly in atypical presentations, such as asymmetric neuropathy or rapid symptom onset.1
Moving Toward Precision
Advancements in diagnostic tools are refining the process. Emerging biomarkers like neurofilament light chain can aid in distinguishing DPN from other neuropathies, while high-resolution imaging techniques like corneal confocal microscopy offer non-invasive insights into nerve health.4
Clinicians must maintain a high index of suspicion when diagnosing DPN, ensuring a thorough exclusion of alternative causes. A structured approach not only enhances diagnostic accuracy but also optimizes patient outcomes by addressing the correct underlying pathology.
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