Underdiagnosis of Peripheral Neuropathy in Type 2 Diabetes
- William H. Herman, MD, MPH1,
- Laurence Kennedy, MD, RCP2 and
- for the GOAL A1C Study Group
- 1Department of Internal Medicine and Epidemiology, University of Michigan Medical Center, Ann Arbor, Michigan
- 2Division of Endocrinology, University of Florida, Gainesville, Florida
- Address correspondence and reprint requests to William H. Herman, MD, MPH, Department of Internal Medicine & Epidemiology, University of Michigan Health System, 1500 East Medical Center Dr., 3920 Taubman Center, Ann Arbor, MI 48109-0354. E-mail: wherman{at}umich.edu
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.
RESEARCH DESIGN AND METHODS
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 …
