A diabetes specialist often uses a monofilament to test for loss of sensation in a patient’s feet, a crucial step in diagnosing neuropathy. Neuropathy, characterized by nerve damage in the hands, feet, or both, can lead to symptoms like numbness, tingling, and sharp pain. Managing risk factors such as diabetes, obesity, and high blood pressure is essential in reducing the likelihood of developing this painful condition.
Key Points to Note:
- Neuropathy Overview: Neuropathy is a medical condition where nerve damage occurs in the peripheral nervous system, typically affecting the hands and feet. This damage results in a range of symptoms including numbness, tingling, and occasionally sharp, stabbing pain. These sensations can significantly impact a person’s quality of life, making everyday tasks challenging and uncomfortable.
- Risks of Untreated Neuropathy: If neuropathy is left untreated, the consequences can be severe. Patients may experience falls due to lack of balance and sensation, leading to injuries. Additionally, cuts and infections may go unnoticed due to numbness, potentially resulting in severe complications. In extreme cases, untreated neuropathy can lead to the need for amputations, particularly among individuals with diabetes who are at higher risk for infections and poor wound healing.
- Underdiagnosis in Low-Income Groups: Recent studies indicate that neuropathy is significantly underdiagnosed, particularly among low-income groups with diabetes. This underdiagnosis can be attributed to several factors, including limited access to healthcare, lack of regular medical check-ups, and insufficient patient education about the symptoms and risks of neuropathy. Early detection through regular screening, such as monofilament tests, is crucial in these populations to prevent severe outcomes.
Managing neuropathy involves a multi-faceted approach, focusing on controlling underlying risk factors. By maintaining healthy blood sugar levels, managing weight, and regulating blood pressure, individuals can significantly reduce their risk of developing neuropathy and mitigate its progression if it does occur. Regular check-ups and proactive healthcare can help identify early signs of neuropathy, ensuring timely and effective treatment.
A study published on May 8 in Neurology revealed that nearly 75% of individuals attending a clinic in Flint, Michigan, which serves a predominantly Black and low-income community, were found to have neuropathy. Alarmingly, the majority of these cases had gone undiagnosed prior to the study.
Peripheral neuropathy, a condition affecting over 20 million Americans, involves nerve damage primarily in the hands and feet. Symptoms often start with numbness, prickling, or tingling sensations, which can progressively extend to the legs and arms. For approximately one-third of those affected, the condition manifests as sharp, jabbing pain that severely impairs their quality of life, frequently resulting in heightened rates of depression.
This study underscores the critical need for improved diagnostic and treatment efforts in underserved communities, where the prevalence of such debilitating conditions is compounded by socioeconomic challenges. Addressing these health disparities is essential to enhancing overall community well-being and reducing the burden of untreated neuropathy.
“This study makes it clear that what we know about neuropathy and the number of people affected by it likely does not represent all the U.S. population,” first author Melissa A. Elafros, MD, PhD, the Andrea and Lawrence A. Wolfe Research Professor of neurology at University of Michigan Medical School in Ann Arbor, said. These findings also stress the need to for better management of risk factors of the condition, she added.
This type of neuropathy is linked to an increased risk of falls, heart disease, and mortality, explains Caitlin Hicks, MD, a professor of surgery and the director of research at the Multidisciplinary Diabetic Foot and Wound Service at Johns Hopkins Medicine in Baltimore.
“Early recognition and risk factor management are critical to prevent the long-term morbidity associated with the disease,” Dr. Hicks, who was not part of the study made, said.
Study Seeks to Close the ‘Huge Gap’ in Research in Some Communities
Most studies on neuropathy and its impact on quality of life have neglected minority and low-income communities like Flint, says Dr. Elafros. This oversight prompted our team to initiate the Flint Neuropathy Study.
“Diabetes is one of the main risk factors for developing neuropathy, and we know that low-income, underserved populations in the United States often have higher rates of diabetes, as well as more diabetes-related complications,” she said.
Researchers Discovered How Almost 3 out 4 Patients at Flint Clinic Suffered from Neuropathy
The study involved 169 participants with an average age of 58. Among them, 69% were non-Hispanic Black, 3% were Hispanic, and 28% were white. Nearly half of the participants reported an annual household income below $20,000, 34% were on disability, and 37% had experienced food insecurity in the past three months.
Participants completed questionnaires assessing their pain levels and the impact on daily activities such as washing their hair, going out, and doing household chores. They also underwent examinations by a neuromuscular neurologist, a specialist in disorders like peripheral neuropathy and ALS (Lou Gehrig’s Disease). The neurologist evaluated their signs and symptoms using a validated and commonly used scale to provide an accurate diagnosis and assess the severity of their condition.
This comprehensive approach highlights the intersection of socioeconomic factors and health, underscoring the importance of inclusive research that addresses the unique challenges faced by minority and low-income communities. By focusing on these often-overlooked populations, the study aims to improve understanding and treatment of neuropathy, ultimately enhancing the quality of life for those most affected.
In the United States, the accepted prevalence rate for neuropathy is 13 for every 100 people, Elafros explained. “Among the adults that participated in our research study, we found that 73 out of every 100 had neuropathy. That’s a huge difference,” she said.
Hicks suggests that one reason for the high rate of neuropathy observed in the study could be the diagnostic test used. Unlike other research, including her own, which often relies on monofilament testing, this study employed a more sensitive method capable of detecting mild and moderate neuropathy.
This allowed us to identify individuals with less severe disease within this predominantly Medicaid patient group, says Hicks.
Most of Participants Suffered from Diabetes and Metabolic Syndrome
Neuropathy was not the only chronic condition affecting participants. Over half had diabetes, and two-thirds were diagnosed with metabolic syndrome. Despite frequent doctor visits, these conditions were often poorly managed.
The authors note that both diabetes and metabolic syndrome are common risk factors for peripheral neuropathy.
“While we did not design this study to determine why there may be gaps in care for medical problems with diabetes, our findings do raise concern that more could be done to address these chronic medical problems to prevent problems like neuropathy,” Elafros said.
Many had Never Been Diagnosed, Even When Symptoms are There
Researchers also found that most people with neuropathy didn’t know they had it. “The majority of neuropathy cases were initially undiagnosed, despite the fact that over half of the participants reported symptoms of neuropathic pain,” Elafros said.
Collaborating with community members and primary care providers is essential to understand why this diagnostic gap exists and to address neuropathy risk factors, she says. This partnership is crucial for improving health outcomes.
“Because there is no cure for neuropathy, most of our management consists of helping to control pain and counsel patients to prevent falls and foot trauma that can lead to cuts, infections, and, even worse, amputations,” Elafros said. But without being properly diagnosed, none of this happens, she further explained.
The key to treatment, says Hicks, is preventing risk factors by identifying and managing metabolic syndrome. This includes addressing high triglycerides, blood pressure, and blood sugar, as well as abdominal obesity and low levels of HDL, or ‘good’ cholesterol.
“This prevalence of new diagnoses is extremely high and represents a real opportunity for health delivery initiatives that focus on preventive, rather than reactive, care,” she said.
Quality of Life Suffers
Hicks notes that even participants in the study with mild to moderate neuropathy reported a significantly lower overall quality of life compared to those without the condition.
“This finding highlights the potential emotional, social, and activity-related impacts of the disease, and further reinforces the need for preventative action,” she said.
Recommended For You
