Summary: Researchers at Cruzeiro do Sul University in São Paulo, Brazil, came up with the idea of a simple device for diagnosis of early signs of diabetic neuropathy. They found that people with diabetes use less force to hold objects. So measuring this force could be a way to find neuropathy early. Diabetic neuropathy is a serious long-term complication of diabetes. But it is very hard to diagnose in its early stages. So many people are diagnosed late. By then, stopping it from getting worse or treating it isn’t easy.
More than 10% of people in the US have diabetes. It is a long-term disorder of how the body handles fuel. There is no cure, though in most cases it can be managed quite well. Many people with diabetes develop long-term complications like blood vessel disease and nerve damage (neuropathies).
It seems that neuropathy shows up in almost all people with diabetes, sooner or later. Yet it is diagnosed in only a small number of cases. Most people never get the diagnosis, because finding mild or early neuropathy takes special equipment or tests.
In most people, neuropathy is diagnosed in the later stages of diabetes. By then, diabetic neuropathy causes loss of feeling in the hands or feet, tingling, or even pain. Diabetic neuropathy pain treatment is one of the biggest challenges. In many cases, drugs do not give enough relief. Also, doctors do not know why neuropathy happens in people with diabetes. It seems to come from two things. One is blood vessel problems. The other is direct nerve damage from the body’s fuel-handling changes.
The condition is hard to treat and almost impossible to reverse, so finding it early can help. But right now there are no biomarkers (body signals that can be measured) or tests to find it early. Still, it seems that researchers at Cruzeiro do Sul University in São Paulo, Brazil, have found a simple way to diagnose neuropathies in their early stages.
It is a simple tool that measures grip strength. That is how much force you use to hold something or handle tools. It appears that measuring it may help find diabetic neuropathy early. It may also help gauge how severe other nerve-wasting (neurodegenerative) disorders are. For example, researchers found that people with Parkinson’s, multiple sclerosis, and other nerve diseases use more strength than needed to hold items. That is how they try to make up for the weakness.
Measuring how much force you use to hold something is simple. Doctors ask you to hold an object with the least force you can for a few seconds. Then they ask you to loosen your grip and let the object slowly fall.
Healthy people know well how much force it takes to hold an object. The spine carries touch signals up to the brain. Then the brain sends the command to use a set amount of force. Most healthy people use 100-120% of the power needed to hold objects. So they squeeze only a bit harder than needed, which saves energy.
But people with neurodegenerative disorders like Parkinson’s use far more force to hold objects, because they have problems in their sensory pathways and brain, too. So they try to make up for those gaps by using more power.
Here is the twist. The researchers found that, unlike people with neurodegenerative disorders, people with diabetes use less force to hold and handle objects.
The study was done on 36 people. Of them, 12 were healthy control subjects. Another 12 had diabetes but no neuropathy diagnosis. The last 12 had diabetes and diabetic neuropathy. All of them were told to handle an object fitted with sensors.
Doctors found that even people with diabetes and no neuropathy diagnosis used less force to hold and handle things. Standard tests had not found neuropathy in them. Yet this simple test showed they already had some early signs.
There are many reasons people with diabetes have a weaker grip or use less force to handle tools. First, they have problems with their sensory nerve cells, so the brain does not get enough information. Second, some spinal pathways are also affected in these people. Finally, there are some changes in the brain, too. These cause them to misjudge how much force they need to handle objects.
So researchers say the next step would be to improve this method and build a device that could help find diabetic neuropathy early. The method is quite simple. A device built on it could be used in any clinic and would not take much training or skill.
Frequently asked questions
Can diabetic neuropathy be detected early?
Not easily today. Right now there are no biomarkers or standard tests for early diabetic neuropathy. Finding mild nerve damage takes special equipment. That is why the grip-force test from Cruzeiro do Sul University matters. People with diabetes who had no neuropathy diagnosis already used less force to hold objects. That was a sign the nerves were changing before routine tests caught it.
How does the grip-force test work?
You hold an object fitted with sensors with the least force you can for a few seconds. Then you slowly loosen your grip and let it fall. Healthy people use about 100-120% of the force needed. People with Parkinson’s use far more. People with diabetes use less, and that drop in grip force is the early warning sign the researchers measured.
What are the symptoms of diabetic neuropathy?
Diabetic neuropathy causes loss of feeling in the hands or feet, tingling, and in many people, pain. By the time these symptoms are obvious, the disease is usually in its later stages. In the early stages most people notice little. That is why the condition goes undiagnosed in most people with diabetes.
Can diabetic neuropathy be reversed?
Diabetic neuropathy is hard to treat and almost impossible to reverse once it sets in. Drugs often do not give enough relief from the pain. That is the case for catching it early. Finding nerve changes before they are advanced gives you the best chance to slow the disease. The other path is chasing symptoms later.
What causes diabetic neuropathy?
Doctors do not know exactly why neuropathy develops in people with diabetes. It appears to come from two directions at once. One is problems with the blood vessels that feed the nerves. The other is direct nerve damage from the metabolic changes diabetes causes. The grip study also found changes in sensory nerves, spinal pathways and the brain’s own sense of how much force to use.
Dr. Gurpreet Singh Padda, MD, MBA, MHP
