Diabetic Neuropathy
+ Balance/Gait
Neuropathy and Fall Risks
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#1 NERVE Supplement Science-Backed by Aaron Vinik MD PhD
Our DTC Chronic Care Programs® – Diabetic Neuropathy + Balance includes our Diabetic Neuropathy Device™ (DND) is the only FDA-registered neuropathy tool that measures both small fiber (temperature) and large fiber (vibration) nerve function in under three minutes—critical because most diabetes-related amputations stem from large fiber neuropathy that often goes undetected with conventional testing. Integrated into our turnkey Chronic Care Programs®, this solution combines comprehensive small and large fiber neuropathy testing with at least 30 seconds of biofeedback-based balance testing and fall risk assessments. These advanced diagnostics support accurate, early detection and proactive management of peripheral neuropathy and related conditions—delivered in-clinic or remotely. With Medicare-eligible CPT codes and seamless workflow integration, we help providers identify, measure, and treat neuropathy earlier, prevent complications, and preserve patient mobility and independence while keeping care and revenue in-house.
Before...
A fall steals independence,
there’s hope and risk 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
Assessing Neuropathy, Balance & Gait
Assessing Neuropathy, Balance & Gait
People with diabetes are living longer, healthier lives due to advances in technology that support early detection screening and timely intervention. These innovations are reshaping chronic care management and elevating standards of outpatient medicine.
Medical providers now have access to non-invasive in-office tools that deliver precise, objective insights—unlike outdated methods such as tuning forks (1711) and monofilaments (1938), which often produce inaccurate results. Relying on subjective tools increases the risk of missed or delayed diagnoses.
Peripheral neuropathy testing—particularly in diabetic and prediabetic patients—is critical to preventing avoidable complications such as falls, ulcers, and amputations. Yet many cases go undetected due to limited diagnostic accuracy in routine exams. Similarly, balance and gait abnormalities often precede serious events but are rarely addressed early.
Our solution integrates AI-powered motion sensors to measure gait symmetry, balance deviation, motor response, and joint mobility in minutes. This enables providers to identify subtle neuromusculoskeletal issues and launch reimbursable care plans that reduce risk and improve outcomes. These tools support:
CMS billable assessments
Reimbursable diagnostics for neuropathy, fall risk, and gait training
Peripheral neuropathy testing with higher sensitivity than monofilaments
Turnkey diabetes care programs that include in-clinic and remote therapy
Seamless integration of cognitive assessments, PAD screening, and cardiovascular risk evaluation
Unlike older methods, these systems provide repeatable, quantifiable results and real-time feedback to guide therapy—improving outcomes while supporting provider efficiency and revenue.
At Diabetes Testing Centers™ (DTC), we’ve integrated this technology into our turnkey diabetes care programs because it represents not just an upgrade, but the future of preventive medicine with continued care in patients home. We believe every provider should have access to tools that improve outcomes while supporting the sustainability of their practice.
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
In the U.S., an estimated that up to 85% of lower extremity amputations among persons with diabetes can be prevented with improved foot care programs.
In the U.S., an estimated that up to 85% of lower extremity amputations among persons with diabetes can be prevented with improved foot care programs.
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
Early detection of peripheral neuropathy, gait instability, and balance dysfunction is critical to preventing falls, ulcers, and amputations—particularly in patients with diabetes. Our non-invasive in-office tools combine peripheral neuropathy testing with balance and gait assessments using real-time motion analytics and biofeedback to evaluate joint symmetry, gait deviation, motor response, and postural control.
Aligned with the latest American Diabetes Association guidelines for early detection screening of distal symmetric polyneuropathy (DSPN), our technology evaluates both small fiber function (temperature) and large fiber function (vibration)—offering one of the most complete CMS billable assessments available.
By detecting the loss of protective sensation (LOPS) and neuromuscular deficits early, providers can initiate timely, reimbursable diagnostics and therapy interventions that improve mobility, reduce fall risk, and limit opioid exposure.
Don't Change Your Workflow, Just Your Tools!
Two Major Modalities in One Simple-to-Use Handheld Device
Two Major Modalities in One Simple-to-Use Handheld Device
Boris Golosarsky, MD MACP FACPI, Podiatry Management, Profiles in Excellence, January 2015
Objectively identify and measure small fiber neuropathy and large fiber neuropathy.
Objectively identify and measure small fiber neuropathy and large fiber neuropathy.
"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
Peripheral neuropathy, when undiagnosed, can lead to foot ulcers and amputations. Legal cases like Washington v. Washington Hospital (1990) have shown that providers may be liable for failing to adopt updated diagnostics. Today’s clinicians must use reimbursable diagnostics and non-invasive in-office tools to detect both neuropathy and balance impairments early—before complications develop.
AI-powered motion sensors now allow precise measurement of gait symmetry, joint mobility, reaction time, and balance deviation—critical for identifying fall risk and loss of protective sensation (LOPS). Treating neuropathy with opioids can mask symptoms and delay care, but early detection screening with targeted therapy leads to better outcomes and fewer hospitalizations.
By integrating neuropathy testing with gait and balance assessments, providers can offer preventive, CMS billable assessments in both clinic and remote settings—enhancing care while increasing revenue.
"...by the time a patient fails the monofilament test, he or she may have a profoundly severe neuropathy, and it may be too late to intervene."
"...by the time a patient fails the monofilament test, he or she may have a profoundly severe neuropathy, and it may be too late to intervene."
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.
Diabetic Neuropathy (DN) is Grossly Underdiagnosed and Undertreated.
Diabetic Neuropathy (DN) is Grossly Underdiagnosed and Undertreated.
Aaron Vinik, MD, PhD, FCP, MACP, FACE, et al, Endocrinologist, Diabetic Neuropathies, February 5, 2018
"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." -Dr. Steve, Neuropathy Centers
Temperature (Small Fiber)
Temperature (Small Fiber)
The Device (DND) Replaces Tuning Forks and Monofilaments...
The Device (DND) Replaces Tuning Forks and Monofilaments...
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.
Site-Specific Predictive Biomarkers
Site-Specific Predictive Biomarkers
Vibration (Large Fiber)
Vibration (Large Fiber)
Importance of Specificity
Diabetic neuropathy and gait instability are two of the most overlooked yet dangerous complications affecting people with diabetes. Over 50% of patients develop some form of peripheral nerve damage—many without symptoms—putting them at serious risk for falls, ulcers, and lower-extremity amputations. In fact, patients with diabetic foot complications face a staggering 80% mortality rate within five years of amputation, underscoring the urgent need for earlier, more effective intervention.
Despite these risks, more than 99% of medical providers still rely on outdated screening tools like tuning forks and monofilaments—developed in the 1700s and 1930s—offering limited insight into the progressive, multifactorial nature of diabetic complications.
Diabetes Testing Centers™ (DTC) provides a smarter solution: advanced, AI-enabled non-invasive in-office tools that combine peripheral neuropathy testing with real-time motion analytics for balance, gait, joint symmetry, and coordination. These technologies are FDA-recognized and integrated into turnkey diabetes care programs designed for primary care settings—no referrals needed, no upfront equipment purchase.
With up to 15 clinical measurements per session, DTC's tools enable early detection screening of small and large nerve fiber dysfunction, postural instability, and movement impairment. This supports comprehensive risk management through CMS billable assessments and reimbursable diagnostics that align with both clinical and financial goals.
Each turnkey program also bundles tools for PAD screening, cognitive assessments, and cardiovascular risk evaluation, helping providers close care gaps while enhancing documentation and compliance with value-based care metrics.
Whether delivered in-clinic or remotely, DTC’s solutions empower providers to detect hidden risks earlier, intervene more effectively, and extend care beyond the walls of the clinic—keeping patients mobile, independent, and out of the hospital.
"It is imperative that we use our ability to measure quantitatively the different types of defects that occur in the disorder (DN), so the appropriate therapies can be targeted to specific nerve fiber types."
"It is imperative that we use our ability to measure quantitatively the different types of defects that occur in the disorder (DN), so the appropriate therapies can be targeted to specific nerve fiber types."
Aaron Vinik, MD, PhD, FCP, MACP, FACE, et al, Endocrinologist, Diabetic Neuropathies, February 5, 2018
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Clinical References (use dropdown)
Rolke R, Magerl W, Campbell KA, et al. Quantitative sensory testing in the German Research Network on Neuropathic Pain (DFNS): standardized protocol and reference values. Pain. 2006; 123(3):231-243.
M.Backonja. Challenges and opportunities for neuropathic pain evaluation in a primary care setting. Third International Congress on Neuropathic Pain. Athens, Greece. 2010:18. Personal communication.
M.Ware. Standardizing the clinical sensory examination. Third International Congress on Neuropathic Pain. Athens, Greece. 2010:18. Personal communication.
G. Mick. Basis for a simple clinical sensory examination in non-specialized practice. Third International Congress on Neuropathic Pain. Athens, Greece. 2010:18. Personal communication.
Boulton AJ,Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by American Diabetes Association. Diabetes Care 2005; 28:956.
http://uptodateonline.com/online/content/topic.do?key=neuropat
Petr Boucek Advanced Diabetic Neuropathy: A Point of no Return? Rev Diabet Stud, 2006, 3(3):143-150.
M. Bharara, MsC, j.e. Cobb, PhD, CEng, and D.J. Claremont, MSc, DPhil, FIPEM
Thermography and Thermometry in the Assessment of Diabetic Neuropathic Foot: A Case for Furthering the Role of Thermal Techniques. Int J Low Extem Wound5(4); 2006pp. 250-260.
Dworkin, RH., editor. Recommendations for the definition, assessment, and pharmacologic management of neuropathic pain. Am J Medicine. 2009; 122:10A (suppl): S1-S31.
Treede RD, Jensen TS, Campbell JN, et. Neuropathic pain: redefinition and a grading system for clinical research purposes. Neurology. 2008; 70: 1630-1635.
National Institute of Health. http://diabetes.niddk.nih.gov/dm/pubs/neuropathies/.
Bouhassira D, Lanteri-Minet M, Attal N, et al. Prevalence of chronic pain with neuropathic characteristics in the general population. Pain. 2008; 136(3):380-387.
Kanji JN, Anglin RE, Hunt DI., et al. JAMA 2010;303(15):1526-1532
Valk, GD,Grootenhuis J TH, Bouter LM., et al. Methods for assessing diabetic polyneuropathy:validity and reproducibility of the measurement of sensory symptom severity and nerve tests. Diabetes research and Clinical practice 2000: 47;87-95.
Vinik AI, Bril V, Litchy WJ, Price KL, Bastyr EJ. Sural sensory action potential identifies diabetic peripheral neuropathy responders to therapy. MBBQ Study Group. Muscle Nerve 2005. 32:619-625 .
DCCT Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Int Med 1995. 122(8):561-568.
Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic on health-related quality of life: review and implications. Neurology 20007;68(15):1178-1182.
Dworkin RH, O’Connor AB, Audette J, et al. Recommendation for the pharmacological management of neuropathic pain: an overview and literature update. Update on guidelines for the treatment of neuropathic pain, including consideration for special population. Mayo Clin Proc. 2010; 85 (3) (suppl): S3-S14.
http://www.disabled-world.com/health/diabetes/diabetic-foot-ulcers.php
http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2011.pdf Centers for Disease Control and Prevention, National Diabetes Fact Sheet, 2011
Guy RJC, Clark CA, Malcolm PN, Watkins PJ: Evaluation of thermal and vibration sensation in diabetic neuropathy. Diabetologia 28: 131–137, 1985.
Vinik AI, Erbas T, Stansberry KB, et al. Small fiber neuropathy and neurovascular disturbances in diabetes mellitus. Exp Clin Endocrinol Diabetes. 2001;109:451–73
Katims JJ. Electrodiagnostic functional sensory evaluation of the patient with pain: A review of the neuroselective current perception threshold (CPT) and pain tolerance threshold (PTT). Pain Digest. 1998;8:219–30.
Archer AG, Watkins PJ, Thomas PK, Sharma AK, Payan J The natural history of acute painful neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry 1983 46: 491–499
Dyck PJ, Zimmerman IR, O'Brien PC, Ness A, Caskey PE, Karnes J, Bushek W) Introduction of automated systems to evaluate touch-pressure, vibration, and thermal cutaneous sensation in man. Ann Neurol 1983 4: 502–510
Fruhstorfer H, Lindblom U, Schmidt WG) Method for quantitive estimation of thermal thresholds in patients. J Neurol Neurosurg Psychiatry 1976 39: 1071–1075
Fagius J, Wahren LK) Variability of sensory threshold determinations in clinical use. J Neurol Sci 1981 51: 11–27
Bloom S, Till S, Sönksen P, Smith S) Use of a biothesiometer to measure individual vibration thresholds and their variation in 519 non-diabetic subjects. Br Med J 1984 288: 1793–1795
Bergström B, Rosberg K, Sundkvist G Autonomic nerve function tests. Reference values in healthy subjects. Clin Physiol 1986 6:523–528
Scott AR, MacDonald IA, Bennett T, Tattersall RB) Abnormal thermoregulation in diabetic autonomic neuropathy. Diabetes 3 1988 7:961–968
Vinik AI, Erbas T, Stansberry KB, et al. Small fiber neuropathy and neurovascular disturbances in diabetes mellitus. Exp Clin Endocrinol Diabetes. 2001;109:451–73
Ohta Akio, Obi Ryusei, Kawata Takehiro, et al. The cold-loaded pain sensation test in the diagnosis of diabetic neuropathy. Jpn J Clin Physiol. 2006;36:47–55.
Masson EA, Boulton AJM. The neurometer: validation and comparison with conventional tests for diabetic neuropathy. Diabetic Med. 1991;8:s63–6
Pitei DL, Watkins PJ, Stevens MJ, et al. The value of the neurometer in assessing diabetic neuropathy by measurement of the current perception threshold. Diabetic Med. 1994;11:872–6.
Suzuki K, Chung Y, Kobayashi Y, et al. Current perception thresholds: a new method for assessment of peripheral sensory neuropathy in diabetes mellitus. Peripheral Nerve. 1995;6:59–63.
Parkhouse N, LeQueen PM. Impaired neurogenic vascular response in patients with diabetes and neuropathic foot lesions. N Engl J Med 1988;318:1306–1309
Stevens MJ, Feldman EL, Greene DA. The aetiology of diabetic neuropathy: the combined roles of metabolic and vascular defects. Diabet Med. 1995;12:566–579
Booya F, Bandarian F, Larijani B, Pajouhi M, Nooraei M, Lotfi J: Potential risk factors for diabetic neuropathy: a case control study. BMC Neurol 2005,10(5):24
Pajouhi M, Shaban Nejad Khas Z, Mohajeri Tehrani M: Evaluation and prevention of diabetic neuropathy (review article). TUMJ2007,65(3):1–6.
Birke J, Rolfsen R: Evaluation of a self-administered sensory testing tool to identify patients at risk of diabetes-related foot. Diab Care1998, 21:23–25
Litzelman D, Marriott D, Vinicor F: Independent physiological predictors of foot lesions in patients with NIDDM. Diab Care 1997, 20:1273–1278
Olaleye D, Perkins BA, Bril V: Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diab Res Clin Prac 2001,54(2):115–128
Nather A, Neo S, Chionh S, Liew S, Sim E, Chew J: Assessment of sensory neuropathy in diabetic patients without diabetic foot problems. J Diabetes Complications 2008,22(2):126–131 Abbott AL, Carrington H, Ashe S, Bath LC, Every J, Griffiths ER, Van Ross AJM: Boulton, North–west diabetes foot care study: incidence of and risk factors for new diabetic foot ulceration in a community-based study. Diab Med 2002, 19:377–384.
Forouzandeh F, Aziz Ahari A, Abolhasani F, Larijani B: Comparison of different screening tests for detecting diabetic foot neuropathy.Acta Neurologica Scandinavica 2005,112(6):409–413.
Dimitrakoudis D, Bril V: Comparison of sensory testing on different toe surfaces: implications for neuropathy screening. Neurology2002,59(4):611–613
Armstrong DG1, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG.Arch Intern Med. 1998 Feb 9;158(3):289-92.Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration.
Armstrong DG, Harvey C, Harkless LB, Giurini JM, Veves A Screening techniques to identify people at high risk for diabetic foot ulceration: a prospective multicenter trial.Pham H1.Diabetes Care. 2000 May;23(5):606-11.
Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2Painful diabetic neuropathy: an update.,*Ann Neurosci. 2011 Oct; 18(4): 168–175. 10.5214/ans.0972-7531.1118409
Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2 Predicted costs and outcomes from reduced vibration detection in people with diabetes in the U.S. Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM22003 Aug;26(8):2305-10.
Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2 Cost-effectiveness of prevention and treatment of the diabetic foot: a Markov analysis. Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2
Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2 Risk factors for foot ulceration in adults with end-stage renal disease on dialysis: study protocol for a prospective observational cohort study. 2015 Sep 18;8:53. doi: 10.1186/s13047-015-0110-9. eCollection 2015. The Thermal Sensitivity Test in Evaluating Outcome after Peripheral Nerve Injury .Biomed Res Int. 2015; 2015: 528356.Published online 2015 Jun 23.
Sharonjeet Kaur,1 Promila Pandhi,1 and Pinaki Dutta, DM2 New diagnostic tests for diabetic distal symmetric polyneuropathy. 2011 Jan-Feb;25(1):44-51.
Arezzo JC, Schaumburg HH, Laudadio C Thermal sensitivity tester. Device for quantitative assessment of thermal sense in diabetic neuropathy.1986 Diabetes 35:590–592.
Bertelsmann FW, Heimans JJ, Weber EJ, van der Veen EA, Schouten JA Thermal discrimination thresholds in normal subjects and in patients with diabetic neuropathy. J Neurol Neurosurg Psychiatry.1985 48:686–690.
Claus D, Hilz MJ, Neundorfer Thermal discrimination thresholds: a comparison of different methods. Acta Neurol Scan B.1990 81:533–540.
Harding LM, Loescher AR Adaptation to warming but not cooling at slow rates of stimulus change in thermal threshold measurements. 2005 Somatosens Mot Res 22:45–48.
Hoitsma E, Reulen JP, de Baets M, Drent M, Spaans F, Faber CG . Small fiber neuropathy: a common and important clinical disorder. J Neurol Sci 2004 227:119–130.
Ijff GA, Bertelsmann FW, Nauta JJ, Heimans JJ Cold and warm cutaneous sensation in diabetic patients. Diabet Med 1991:8:S71–73.
Kenshalo DR, Bergen). A device to measure cutaneous temperature sensitivity in humans and subhuman species. J Appl Physiol DC 1975: 39:1038–1040.
Lin YH, Hsieh SC, Chao CC, Chang YC, Hsieh ST . Influence of aging on thermal and vibratory thresholds of quantitative sensory testing. J Peripher Nerv Syst 2005 10:269–281.
Maser RE, Nielsen VK, Bass EB, Manjoo Q, Dorman JS, Kelsey SF, Becker DJ, Orchard TJ (). Measuring diabetic neuropathy. Assessment and comparison of clinical examination and quantitative sensory testing. Diabetes Care 1989 12:270–275.
Palmer ST, Martin DJ, Steedman WM, Ravey J C- and Adelta-fibre mediated thermal perception: response to rate of temperature change using method of limits. Somatosens Mot Res 2000 17:325–333.
Yarnitsky D, Sprecher Thermal testing: normative data and repeatability for various test algorithms. J Neurol Sci E 1994. 125:39–45.
Thermal discrimination and Weber's law: with a theory on the nature and function of sensory adaptation. Culler, E. A.Archives of Psychology, Vol 13, 81, 1926, . Sense of Touch and Common Feeling. E.H.Weber 1846
Golosarsky B. Can Heart Rate Variability timing reflect the body stress? 2006 Medical Hypothesis, V. 67, 1467-146
Golosarsky B. Making Neuropathy Screening exam Truly Comprehensive in 5 minutes. Profiles in Excellence. Podiatry Management, 2015 January 155-156
Golosarsky B., et al. 2013 U.S. Patent 8,579,830 Neuropathy Diagnostic Device.
Golosarsky, B., et al. Patent Office, Japan 2011-518739 Neuropathy Diagnostic Device.
Bakkers M1, Faber CG, Peters MJ, Reulen JP, Franssen H, Fischer TZ, Merkies IS Temperature threshold testing: a systematic review. J Peripher Nerv Syst. 2013 Mar;18(1):7-18
Metin Yavuz M, D.Eng, D.G. Armstrong , DPM, MD, PhD, et al; Temperature as a Causative Factor in Diabetic Foot Ulceration: A Call to Revisit Ulcer Pathomechanics; Journal of the American Podiatric Medical Association 2018
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