1 Room. 20 Programs. 100% Medicare Eligible.
DTC Neuropathy Care Clinics® specializes in providing neuropathy services for the early detection, diagnosis, and management of peripheral neuropathy and related conditions. These centers utilize advanced, FDA-cleared diagnostic tools to assess nerve function, detect damage, and identify potential risk factors in patients. Identify. Measure. Treat.
Before...
Amputations rob evening walks with family,
there’s hope and early detection at DTC.
"Every medical practice should test patients with the DND before referring them to a specialist because it can help identify potential underlying conditions that may require further investigation or treatments." -J. Gonzalez MD, Neurologist
Kazu Suzuki DPM, Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles, CA; Managing Neuropathy And Pain In Wound Care Patients, Podiatry Today; September 2015; 26-27.
Get Reimbursed for Foot Exams
Diabetic and Non-Diabetic
Diabetic Neuropathy Accounts for More Hospitalizations Than All Other Diabetic Complications Combined...
Aaron Vinik, MD, Ph.D., Endocrinologist, Diabetic Neuropathies, February 5, 2018
"The DND has improved the patient understanding of their disease, which is very helpful." - W. Beaton DPM
Bild DE, et al. Lower Extremity Amputations in People with Diabetes: Epidemiology and Prevention. Diabetes Care 1989; 12:24-31; CDC MMWR November 01, 1991 / 40(43);737-7
"We regularly use the Diabetic Neuropathy Device™ (DND) to monitor our diabetic patients who are at risk for developing diabetic neuropathy, as well as patients who are already diagnosed with diabetic neuropathy." -C. Soller NP, Endocrinology
Modern Technology
The Diabetic Neuropathy Device™ (DND) meets the new American Diabetes Association (ADA) Diabetes screening and diagnosis recommendations. It is the only tool capable of screening distal symmetric polyneuropathy (DSPN), which includes the assessment of temperature (small fiber function) and vibration (large fiber function), as recommended in the new Diabetic Neuropathy: A Position Statement by the American Diabetes Association.
Neuropathy treatments should be tailored to address each patient's unique clinical presentation and underlying pathogenesis without exposing them to the harmful side effects of opioids. For instance, if a patient with painful neuropathy is given medication to alleviate the pain, it may mask and hide the loss of protective sensation (LOPS) in their feet, increasing the risk of foot ulcers and amputation. Therefore, identifying individuals in the early stages of the neuropathic process is crucial to reducing risk factors more effectively.
Don't Change Your Workflow, Just Your Tools!
Boris Golosarsky, MD MACP FACPI, Podiatry Management, Profiles in Excellence, January 2015
"We use the DND because it gives us both the small and large fiber results that we feel are important for every diabetic patient." -R. Cardenas MD, Family Practice
Morbidity and Mortalities
Neuropathy is a serious condition that, if not diagnosed properly, can lead to lower-extremity amputations of the toes, feet, or legs. Medical institutions and physicians have been found liable for medical malpractice due to their failure to adopt new technologies or procedures. This has been demonstrated in the case that set legal precedence in the U.S., Washington v. Washington Hospital (1990). Clinicians need to stay informed of emerging best practices based on clinical evidence to reduce risks. By focusing on prevention and reallocating resources, the appropriate therapy can be given, resulting in fewer inpatient and outpatient visits and improved quality of life.
Kazu Suzuki DPM, Medical Director of the Tower Wound Care Center at the Cedars-Sinai Medical Towers in Los Angeles, CA; Managing Neuropathy And Pain In Wound Care Patients, Podiatry Today; September 2015; 26-27.
Aaron Vinik, MD, PhD, FCP, MACP, FACE, et al, Endocrinologist, Diabetic Neuropathies, February 5, 2018
Identifying the following nerve fibers may increase earlier awareness and interventions:
Aα fibers are large myelinated fibers in charge of motor functions and muscle control.
Aβ fibers are large myelinated fibers with sensory functions such as perception to touch, vibration, and position.
Aδ fibers are small myelinated fibers in charge of pain stimuli and cold perception.
C fibers can be myelinated or unmyelinated and have sensory (warm perception and pain) and autonomic functions (blood pressure and heart rate regulation, sweating, etc.).
"One of the great advantages of using the DND on our diabetic patients who have started to develop diabetic neuropathy, is that showing them their results, often makes the consequences of not taking care of themselves more realistic." -S. Erle DC, Neuropathy Centers
Importance of Specificity
Diabetics that have lower-extremity amputations have lifespans that range between 40% mortality in 1-year, 65% mortality in 3-years, and 80% mortality in 5-years. Diabetic Neuropathy is a serious diabetes complication affecting as many as 50% of people who suffer from pain, and another 50% may be asymptomatic - who are at the highest risk of falls, ulcerations, and amputations. Nerve damage and poor circulation are the most common causes of diabetic foot problems. One of the most underdiagnosed and untreated parts of a comprehensive foot exam is checking the loss of protective sensation (LOPS) in the feet. The diabetic large nerve fiber dysfunction, as measured by vibration, predicts foot ulcerations, amputations, and mortality.
https://care.diabetesjournals.org/content/32/10/1896
The purpose of a comprehensive diabetic foot exam is to gather as much clinical data about the condition of a person's normal or abnormal condition in the feet of both large and small nerve fibers. A diabetic foot exam also checks people with diabetes for infection, injury, and bone abnormalities. However, over 99% of all medical providers use outdated and subjective tools (tuning fork, invented in 1711 or monofilaments, invented in 1938) to identify a progressive disease. Distal Symmetric Polyneuropathy (DSPN), a glove and stocking distribution, is the most common form of Diabetic Neuropathy (DN) and is recognized as the most troublesome complication of diabetes mellitus leading to the greatest morbidity and mortality, which accounts for the most amount of hospitalizations than all other diabetic complications combined and is responsible for up to 75% of non-traumatic amputations.
Aaron Vinik, MD, Ph.D., Endocrinologist, Diabetic Neuropathies, February 5, 2018
The proper diagnosis of diabetic neuropathy should require tools to identify and measure the disorder quantitatively for the different abnormalities that occur to specific nerve fibers. Combining at least two different examinations (large and small fiber) will increase the sensitivity and specificity of detecting DPN. Currently, many medical providers are unaware of reimbursable tools that address both large fiber and small fiber neuropathy, both of which manifest in patients with diabetes. The Diabetic Neuropathy Device™ is the first FDA Cleared multi-objective tool with 15 measurements that identify both large and small nerve fibers in the upper and lower extremities.
Aaron Vinik, MD, PhD, FCP, MACP, FACE, et al, Endocrinologist, Diabetic Neuropathies, February 5, 2018
The sympathetic skin response is a simple, reproducible, and non-invasive test based on modifying the skin potential of peripheral nerves. Sympathetic skin response has been used to diagnose polyneuropathy, erectile dysfunction, central degenerative diseases, multiple sclerosis, brain infarction, reflex sympathetic dystrophies, spinal, and peripheral nerve lesions. The Diabetic Neuropathy Device™ is a modern tool that uses the SSR to help patients discriminate against variable temperature and vibration stimuli.
Quantitative Sensory Testing (QST) and Sympathetic Skin Response tests (SSR) are distinct diagnostic procedures employed to assess the nervous system: QST focuses on evaluating sensory function by measuring the perception of stimuli, including touch, temperature, and pressure, commonly used in neurology to assess peripheral neuropathy; whereas SSR assesses the sympathetic nervous system's activity by measuring changes in skin conductance in response to stress or stimuli, often applied in neurology to evaluate autonomic nervous system function, with key differences lying in their respective focuses, stimuli application methods, and measurements. Multiple studies have proven the value of Quantitative Sensory Testing (QST) measures in the detection of subclinical neuropathy (small fiber neuropathy), the assessment of the progression of neuropathy, and the prediction of the risk of foot ulceration (117,129,130). These standardized measures of vibration and thermal thresholds also play an important role as primary efficacy endpoints in multicenter clinical trials.
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