3.0.0.0 NEU­ROPA­THY

3.1.0.0 Rec­om­men­da­tions

Rec­om­men­da­tions

Screen­ing

11.26 All pa­tients should be as­sessed for di­a­bet­ic pe­riph­er­al neu­ropa­thy start­ing at di­ag­no­sis of type 2 di­a­betes and 5 years after the di­ag­no­sis of type 1 di­a­betes and at least an­nu­al­ly there­after. B

11.27 As­sess­ment for dis­tal sym­met­ric polyneu­ropa­thy should in­clude a care­ful his­to­ry and as­sessment of ei­ther tem­per­a­ture or pin­prick sen­sa­tion (small-‍ fiber func­tion) and vi­bra­tion sen­sa­tion using a 128-Hz tun­ing fork (for large-‍fiber func­tion). All pa­tients should have an­nu­al 10-g monofilament test­ing to iden­tify feet at risk for ul­cer­a­tion and am­pu­ta­tion. B

11.28 Symp­toms and signs of au­to­nom­ic neu­ropa­thy should be as­sessed in pa­tients with microvas­cu­lar com­pli­ca­tions. E

Treat­ment

11.29 Op­ti­mize glu­cose con­trol to pre­vent or delay the de­vel­op­ment of neu­ropa­thy in pa­tients with type 1 di­a­betes A and to slow the pro­gres­sion of neu­ropa­thy in pa­tients with type 2 di­a­betes. B

11.30 As­sess and treat pa­tients to re­duce pain re­lat­ed to di­a­bet­ic pe­riph­er­al neu­ropa­thy B and symp­toms of au­to­nom­ic neu­ropa­thy and to improve quality of life. E

11.31 Pregabalin, duloxetine, or gabapentin are recommended as initial pharmacologic treatments for neuropathic pain in diabetes. A

The diabetic neuropathies are a heterogeneous group of disorders with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is important.

  1. Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be present in patients with diabetes and may be treatable.
  2. Numerous treatment options exist for symptomatic diabetic neuropathy.
  3. Up to 50% of diabetic peripheral neuropathy (DPN) may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk for injuries to their insensate feet.
  4. Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life. Specific treatment for the underlying nerve damage, other than improved glycemic control, is currently not available. Glycemic control can effectively prevent DPN and cardiac autonomic neuropathy (CAN) in type 1 diabetes (105,106) and may modestly slow their progression in type 2 diabetes (32), but does not reverse neuronal loss. Therapeutic strategies (pharmacologic and nonpharmacologic) for the relief of painful DPN and symptoms of autonomic neuropathy can potentially reduce pain (107) and improve quality of life.