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J Biol Chem 264:2160821612 Prentki M, Vischer S, Glennon MC, Regazzi R, Deeney JT, Corkey BE (1992) Malonyl-CoA and long chain acyl-CoA esters as metabolic coupling factors in nutrient-induced insulin secretion

The factors considered responsible for the challenges in recognition and timely diagnosis of DPN include: a) the insidious course of disease manifesting with non-specific symptoms and signs mimicking many other diseases, b) a lack of consensus on optimal screening and diagnostic procedures, c) the absence of a well-established diagnostic scrutiny, and d) the poor acceptance of guidelines and insufficient awareness of the disease among physicians (30, 5658)