New Guidelines Released for Diabetic Neuropathy Care

Lauren Santye, Assistant Editor
Published Online: Tuesday, January 31st, 2017
New guidelines regarding the prevention, treatment, and management of diabetic neuropathy have been released in a position statement published in Diabetes Care.

A group of endocrinologists and neurologists, led by investigators at Michigan Medicine, partnered with the American Diabetes Association (ADA) to craft a new position statement that provides physicians with more information and guidelines for the condition.

The paper stresses the importance of preventing diabetic neuropathy because treatments to reverse the underlying nerve damage are lacking.

Although the ADA released a statement on diabetic neuropathy in 2005, the new update better reflects the current landscape of care, according to the authors.

“Our goal was to update the document so that it not only had the most up-to-date evidence, but also was easy to understand and relevant for primary care physicians,” said lead author Rodica Pop-Busui, MD, PhD. “We wanted it to be accessible to whoever takes care of diabetes patients, not just specialists.

Currently, many physicians will use different classifications for neuropathies. To address this, the authors sought to unify the different forms of diabetic neuropathy into a more “objective and easy-to-follow recommendation method.”

The investigators came to a consensus to classify them in a more logical format for clinical care.

“We asked ourselves: What are the critical steps that have to be followed to diagnose diabetic neuropathy efficiently without ordering unnecessary evaluations for the patient, which can be expensive and may involve wait times? We agreed on an algorithm that can be used in the clinical care setting so physicians have an easier understanding of when to perform a center evaluation or when they should refer the patient to a neurologist,” Pop-Busui said.

The classification system for diabetic neuropathies was divided into 3 main types: diffuse neuropathy, mononeuropathy, and radiculopathy or polyradiculopathy.

Diffuse neuropathy was further broken into 2 categories: peripheral and autonomic. Peripheral affects the hands and feet, whereas autonomic affects internal organs. Examples include distal symmetric polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN).

Mononeuropathy occurs when a single nerve or isolated nerve group is damaged, according to the guidelines. Radiculopathy occurs when the root of a nerve is pinched.

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