Interviewer: Dr. Khalfin, let’s start with the basics. What exactly is the TM-Flow test?
Dr. Khalfin: I get this question a lot! Simply put, TM-Flow is a quick, painless screening test that helps us evaluate indicators related to autonomic nervous system function and peripheral circulation, including how the nerves and small blood vessels in your body may be working.
Most people know that diabetes can affect the feet, the heart, the kidneys, and the eyes. What many don’t realize is that diabetes can also affect the nerves that control things like your heart rate, blood pressure, sweating, digestion, and circulation—and these changes often begin long before you notice any symptoms.
The TM-Flow test can help us look for early warning signs that may not show up in routine blood work or be noticeable to the patient yet.
Interviewer: If a patient has blood work done, why isn’t that enough?
Dr. Khalfin: Blood work tells me how well we’re controlling diabetes. I can see your A1c, your cholesterol, your kidney function, and many other important numbers.
But blood work can’t tell me how your nerves are functioning.
Think of it this way. Two patients may have exactly the same A1c, but one has healthy nerves while the other is already developing early nerve damage. The TM-Flow test gives me another piece of the puzzle.
It’s not a replacement for blood work, a physical exam, or other testing—it’s something that complements them.
Interviewer: Who do you recommend this test for?
Dr. Khalfin: In our practice, we use TM-Flow primarily for patients with diabetes.
Some patients have had diabetes for many years. Others were diagnosed only recently. Regardless of how long you’ve had diabetes, we need to think about preventing complications before they become serious.
If we identify early changes, we may have a chance to slow them down and, in some cases, improve certain measurements over time.
That’s much better than waiting until someone develops severe numbness or pain.
Interviewer: What is the test like? Should patients expect anything uncomfortable?
Dr. Khalfin: Not at all.
The test is very simple. You sit comfortably in a chair while small sensors are placed on your hands and feet. There’s no blood draw, no needles, and no discomfort.
It usually takes about 10 to 15 minutes, and you can go right back to your normal activities afterward.
Interviewer: Do patients need to do anything to prepare for the test?
Dr. Khalfin: Preparation is usually very simple. We want patients to be comfortable and relaxed during the test. In general, it is helpful to avoid applying heavy lotion or cream to the hands and feet before the appointment because the sensors need good contact with the skin.
If there are any special instructions based on a patient’s medical history or medications, our team will review those with the patient ahead of time.
Interviewer: Is the TM-Flow test usually covered by insurance?
Dr. Khalfin: In most cases, insurance covers the TM-Flow test, and patients do not have any out-of-pocket costs. Coverage varies depending on the patient’s specific insurance plan, so our team can help review benefits and answer any billing questions before the test is performed.
Interviewer: When you review the report, what are you looking for?
Dr. Khalfin: I always tell my patients that I’m not looking for anything magic, such as some magic number.
Instead, I’m looking at the overall picture.
I’m looking at how well the nerves that help regulate your heart rate, blood pressure, sweating, and blood vessel tone appear to be functioning. I’m looking for signs that the small nerves in your feet may be under stress. I’m also looking at measurements related to circulation.
All of that helps me understand whether diabetes may already be affecting your body, even if you’re feeling fine.
Interviewer: If the test comes back abnormal, should patients be worried?
Dr. Khalfin: Not necessarily.
An abnormal result doesn’t mean something terrible is happening. More often, it tells me that we need to pay closer attention.
It may be a sign that we should work harder to improve the patient’s blood sugar, encourage more physical activity, adjust medications, or focus on weight loss and other healthy habits. Depending on the findings and the patient’s overall health, I may also recommend follow-up with a cardiologist or neurologist.
I actually like finding problems early because that’s when we have the greatest opportunity to do something about them.
Interviewer: Can the results improve over time?
Dr. Khalfin: Absolutely—and that’s exactly what I like about this test.
Many patients work very hard to manage their diabetes. They improve their eating habits, become more active, lose weight, and lower their A1c.
It’s wonderful when we see those improvements in the blood work, but it’s even better when we also see signs that certain nerve and circulation-related measurements may be improving compared with six or twelve months earlier.
That’s why I often recommend repeating the TM-Flow test after we’ve had time to work on a treatment plan. It allows us to measure progress, not just assume it’s happening.
Interviewer: What happens after the test is completed?
Dr. Khalfin: We review the report in the context of the whole patient—their symptoms, exam, medical history, blood work, medications, and risk factors. The results may help guide the conversation about prevention, lifestyle changes, medication adjustments, or whether additional evaluation is needed.
The most important point is that the test is one part of a larger care plan. We use it to support better decision-making, not to make decisions in isolation.
Interviewer: If there’s one thing you’d like your patients to remember about TM-Flow, what would it be?
Dr. Khalfin: Diabetes doesn’t usually cause complications overnight. Most problems develop slowly, over a long period of time, sometimes many years.
Our goal is to stay one step ahead.
The TM-Flow test gives me another way to look beneath the surface and may help identify changes before they become bigger problems. It’s another tool that helps me provide more personalized care and gives my patients the best opportunity to stay healthy.
If you have diabetes and are interested in learning whether TM-Flow testing is appropriate for you, ask our care team at your next visit.
Important note: TM-Flow is a screening and monitoring tool. It does not diagnose a medical condition by itself. Results should be interpreted by a qualified healthcare provider together with the patient’s symptoms, physical exam, medical history, blood work, and any other appropriate testing.
