Diabetic neuropathy of the lower limbs is a chronic complication with an insidious, progressive, and irreversible onset that occurs asymptomatically and develops symptomatically over the years. Currently, there are many non-invasive instruments for screening diabetic neuropathy such as the Michigan Neuropathy Screening Instrument (MNSI), Neuropathy Disability Score (NDS), Toronto Clinical Neuropathy Screening (TCNS), Quantitative Sensory Testing (QST)3,4,5. This last instrument (QST) has the advantage of evaluating myelinated and unmyelinated sensory fibers quantitatively through the response to different stimuli: mechanical, thermal, and painful 2. This screening instrument was applied to two diabetic patients without symptoms of diabetic neuropathy of the lower limbs to detect early neuropathic signs. The peripheral nerve assessment was repeated 4 months after intensified management of metabolic control to evaluate the possibility of reversibility of any sensory damage.

Traditional instruments for screening diabetic neuropathy do not detect early and do not quantitatively evaluate the state of the different sensory fibers. In this case, the monofilament and the tuning fork gave negative results for neuropathy in both patients; so, monofilament und tuning fork not detected early the damage of the fiber, nor evaluate the progression over time 1. In the first case there was an improvement in all sensory fibers. Unfortunately, in the second case not all fibers recovered, possibly due to poor metabolic control since the beginning of the T2DM diagnosis, but we can observe that the progression of damage was stopped in some fibers while in others they recovered. The QST screening instrument can diagnose early sensory neuropathy and provides the opportunity to act more aggressively in metabolic control for reversing damage to sensory fibers and preventing neuropathy from establishing irreversibly and progressing to neuropathic diabetic foot painful, Charcot arthropathy and finally to the fearful and regrettable amputations.