Pin-prick (Medipin) assessment for neuropathy in diabetes: prospective screening study in primary care

Fisher, Stacey, Gray, Hannah, Kelsall, Nicci, Lowes, Donna and Jonker, Leon ORCID: https://orcid.org/0000-0001-5867-4663 (2024) Pin-prick (Medipin) assessment for neuropathy in diabetes: prospective screening study in primary care. Primary Care Diabetes, 18 (6). pp. 612-617.

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Abstract

Highlights
• Screening for diabetic neuropathy is indicated to minimise patient complications.
• Monofilament testing of feet is used most in primary care despite test limitations.
• The Medipin device allows safe pin-prick testing to screen for small nerve function.
• Compared to monofilament, Medipin diagnoses more patients with nerve impairment.
• Due to role in pain perception, small nerve testing may benefit diabetic patients.

Abstract
Aims: Diabetic patients are at elevated risk of neuropathy; early detection is desirable to minimise the risk of complications. The Medipin pin-prick device was appraised as a screening tool for diabetic neuropathy.

Methods: Prospective cross-sectional comparative screening study in primary care setting, involving 389 participants with type 2 diabetes mellitus. The Medipin pin-prick method, involving dorsal application on the hallux of both feet, was compared to 10 g monofilament testing.

Results: The ternary and semi-quantitative approach for scoring Medipin pin-prick sensation give very similar results (Spearman rho 0.67, P < 0.001). A total of 59 % patients had no signs of neuropathy (sharp sensation), 38 % reported impaired sensation (dull sensation), and an absence of sensation occurred in 3 % of patients. For the monofilament dorsal method, the figures were 79 % no neuropathy, 14 % elevated risk, and 7 % neuropathy respectively, and with the monofilament plantar method 87 % of patients had no neuropathy and 13 % did. Correlation analyses showed that taller patients and those with existing neuropathic pain are at very modest increased risk of neuropathy.

Conclusions: The Medipin pin-prick device can identify diabetic neuropathy and detects (first signs of) neuropathy in relatively more patients than 10 g monofilament testing. The differential targeting of nerve types, namely predominant small (Medipin) versus large (monofilament) fibre, likely underpins the difference in outcomes.

Item Type:	Article
Journal / Publication Title:	Primary Care Diabetes
Publisher:	Elsevier
ISSN:	1878-0210
Departments:	Institute of Health > Medical Sciences
Additional Information:	This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
Depositing User:	Anna Lupton
Date Deposited:	22 Oct 2024 13:49
Last Modified:	02 Dec 2024 10:00
URI:	https://insight.cumbria.ac.uk/id/eprint/8466

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