Sec­tion 12. Retinopa­thy, Neu­ropa­thy, and Foot Care

(https:/​/​doi.org/​10.2337/​dc23-​S012)

Lan­guage re­gard­ing preg­nan­cy as a risk fac­tor for retinopa­thy in peo­ple with pre­ex­ist­ing type 1 or type 2 di­a­betes was re­vised and up­dat­ed.

Screen­ing de­tails about au­to­nom­ic neu­ropa­thy were added to Rec­om­men­da­tion 12.17.

Lan­guage was added to the neu­ropa­thy screen­ing sub­sec­tion to clar­i­fy that treat­ments of oth­er modifiable risk fac­tors (in­clud­ing lipids and blood pres­sure) can aid in pre­ven­tion of di­a­bet­ic pe­riph­er­al neu­ropa­thy pro­gres­sion in type 2 di­a­betes and may re­duce dis­ease pro­gres­sion in type 1 di­a­betes.

In­for­ma­tion was added to the “Di­a­bet­ic Au­to­nom­ic Neu­ropa­thy“ sub­sec­tion to in­clude cri­te­ria for screen­ing for symp­toms of au­to­nom­ic neu­ropa­thy.

Ad­di­tion­al ref­er­ences were added to sup­port Rec­om­men­da­tion 12.18.

Rec­om­men­da­tion 12.20 was re­vised to reflect that gabapenti­noids, sero­tonin­nore­pinephrine re­up­take in­hibitors, tri­cyclic an­tide­pres­sants, and sodi­um chan­nel block­ers are rec­om­mend­ed as ini­tial phar­ma­co­log­ic treat­ments for neu­ro­path­ic pain in di­a­betes and that health care pro­fes­sion­als should re­fer to a neu­rol­o­gist or pain spe­cial­ist when pain con­trol is not achieved with­in the scope of prac­tice of the treat­ing physi­cian.

New in­for­ma­tion was added in the “Neu­ropa­thy“ sub­sec­tion, un­der “Treat­ment,“ to ad­dress lipid con­trol and blood pres­sure con­trol.

The “Neu­ro­path­ic Pain” sub­sec­tion in­cludes an ex­pand­ed dis­cus­sion of treat­ing neu­ro­path­ic pain in peo­ple with di­a­betes. Rec­om­men­da­tion 12.25 was added to ad­dress screen­ing for pe­riph­er­al ar­te­ri­al dis­ease.

Rec­om­men­da­tion 12.26 was re­vised to in­clude pe­riph­er­al ar­te­ri­al dis­ease.

Rec­om­men­da­tion 12.27 was edit­ed to sig­ni­fy that not all peo­ple who smoke are re­ferred to foot care spe­cial­ists but that a re­fer­ral is now rec­om­mend­ed for peo­ple who smoke and also have oth­er risk fac­tors or symp­toms.

Rec­om­men­da­tion 12.29 was edit­ed to reflect a change from “se­vere neu­ropa­thy“ to “loss of pro­tec­tive sen­sa­tion,“ which is con­sis­tent with oth­er rec­om­men­da­tions.

Rec­om­men­da­tion 12.30 was edit­ed to reflect that top­i­cal oxy­gen ther­a­py is not equiv­a­lent to hy­per­bar­ic oxy­gen ther­a­py.