Update on the Management of Diabetic Neuropathy

Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of...

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Bibliographic Details
Published in:Diabetes spectrum 2018-08, Vol.31 (3), p.224-233
Main Authors: Ang, Lynn, Cowdin, Nathan, Mizokami-Stout, Kara, Pop-Busui, Rodica
Format: Article
Language:English
Subjects:
Abuse
Addictions
Amputation
Arrhythmia
Autonomic nervous system
Cardiovascular disease
Cardiovascular diseases
Diabetes
Diabetes mellitus
Diabetic neuropathy
Diagnosis
Disease management
From Research to Practice
Gastric emptying
Hyperglycemia
Hypoglycemia
Ischemia
Morbidity
Mortality
Opioids
Polyneuropathy
Risk factors
Risk groups
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Summary:Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of typical symptoms combined with symmetrical, distal-to-proximal stocking-glove sensory loss. CAN is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, major cardiovascular events, and myocardial dysfunction. Screening for CAN in high-risk patients is recommended. Symptoms of gastroparesis are nonspecific and do not correspond with its severity. Diagnosis of gastroparesis should exclude other factors well documented to affect gastric emptying such as hyperglycemia, hypoglycemia, and certain medications. There is a lack of treatment options targeting the neuropathic disease state. Managing neuropathic pain also remains a challenge. Given the high risk of addiction, abuse, psychosocial issues, and mortality, opioids are not recommended as first-, second-, or third-line agents for treating painful DSPN.
ISSN:1040-9165
1944-7353
DOI:10.2337/ds18-0036