Tuning Fork May Be Superior as Diabetic Neuropathy Screen

But Dr. Andrew J.M. Boulton, chair of the American Diabetes Association's Foot Care Interest Group, said he believes that it's too soon to replace the monofilament with the CTF as a first-line screening test for diabetic neuropathy. The CTF results are “of course very interesting, and I think that this is certainly a useful addition to the monofilaments,” he said in an interview.

Dr. Boulton, who divides his time between the Manchester (England) Diabetes Centre and the University of Miami, noted that data from prospective studies also support the monofilaments. In one review of six such studies, the increased risk of ulceration ranged from an odds ratio of 2.2 to 9.99, and the relative risk of amputation was 2.9 with an abnormal monofilament test (J. Fam. Pract. 2000;49[11 Suppl]:S17–29).

“What is needed with this test is a prospective study. …This new tuning fork test may well be useful but before it can replace the monofilament—if it is to at all—good longitudinal studies must be done,” said Dr. Boulton, who has received honoraria/consulting fees from Pfizer and Eli Lilly & Co.

Dr. Oyer and Dr. Saxon stated that they had no conflicts of interest to disclose.