TM Flow Device
TM Flow Device

The TM Flow is proving to be an invaluable diagnostic tool in the detection of Cardiac Autonomic Neuropathy (CAN). CAN is a serious and underdiagnosed complication of diabetes. Early detection of CAN is possible for physicians in the primary care field, with the right equipment, such as the TM Flow and knowledge.

Traditional testing methods for diabetic neuropathy, has largely been confined to peripheral neuropathy and at a highly subjective level. Technology now enables physicians to accurately assess risk and diagnosis of neuropathy, objectively. Early diagnosis with these methods, can significantly improve patient outcomes through increased awareness, proactive care and treatment.

A study performed in 2015 (1) suggests that standardized testing for cardiovascular autonomic function be performed after diagnosis of type 2 diabetes. The article suggests that an imbalance of the cardiac and vasomotor nervous system is present in some patients, even at initial diagnosis of diabetes type 2. This suggests that neuropathy can manifest very early on. Subtle abnormalities may begin before diabetes or insulin resistance is even recognized.

The reasons for early testing were outlined:

  • CAN was highly prevalent 6 years after Diabetes type 2 diagnosis
  • The Steno-2 Trial suggested that patients with long standing type 2 diabetes, with multifactorial intervention, can reduce the risk of CAN developing by 68%
  • Early treatment provides a greater variety of therapeutic treatment options when compared to treatment at advanced stages.

Hypertension and obesity can be predictors for CAN and flag further evaluation of the patient for CAN.

Consequences of CAN on patients is significant with an increased risk of sudden death, abnormal heart rhythm and vascular dynamics.

Neuropathy is a well know progression of diabetes, particularly so for those with poorly controlled disease. Peripheral neuropathy typically is detected after loss of sensation has already occurred, exposing the patient to a risk of falls. CAN too is widely under diagnosed at an early stage. Without specific equipment and training, the condition can be hard to pinpoint.

Some doctors get confused about the benefits of ANS testing and my take has always been nerves get sick before they die. Testing at an early stage helps physicians detect when nerves first get sick. The information from these tests can provide an objective assessment and capture at risk patients early.

Capital expenditure on the equipment can be quickly recouped and the low or absence of cost of consumables makes these technologies a valuable tool for early detection and monitoring of the diabetic patient.

For a copy of the article or more information about early detection, contact me directly at or via LinkedIn.

(1) Zoppini G, Cacciatori V, Raimondo D, et al. Prevalence of Cardiovascular Autonomic Neuropathy in a Cohort of Patients With Newly Diagnosed Type 2 Diabetes: The Verona Newly Diagnosed Type 2 Diabetes Study (VNDS). Diabetes Care; Vol 38: 1487-1493.