Background
Present in up to 10%–15% of DM patients at the time of diagnosis. It’s present in up to 50% of patients within 10 years of diagnosis.
AKA: Diabetic Peripheral Neuropathy
Diagnosis
How is the diagnosis made?
Treatment
1st-line treatments
-Pregabalin (FDA approved)
-Duloxetine (FDA approved)
Other Medications that work.
Tricyclic antidepressants – Significant side effects. Avoid in elderly.
Anticonvulsants,
Topical capsaicin.
SSRIs don’t work.
NSAIDs, TENS, ACE inhibitors lack systematic evidence.
No significant evidence supporting glycemic control or lifestyle interventions as effective treatment for DSPN.
“Patients who have diabetic neuropathy with impairment of vibratory sense and reduced sensation to a 10-g monofilament are at higher risk of injury during physical activities because of the loss of protective sensation in the feet. Physical activities that should be avoided include treadmill use, prolonged walking, jogging, and step exercises. Recommended exercise activities include swimming, bicycling, rowing, chair exercises, arm exercises, and other non–weight-bearing exercise. On the basis of recent studies, the American College of Sports Medicine and the American Diabetes Association recently concluded that moderate walking is permissible, as it does not increase risk of foot ulcers or re-ulceration in those with peripheral neuropathy.” ABFM
Reference / Further Reading
Diabetes Care 2017;40(1):136-154. Diabetic neuropathy: A position statement by the American Diabetes Association.