A new position statement on the prevention, treatment, and management of diabetic neuropathy has been released by a team of endocrinologists and neurologists in conjunction with the American Diabetes Association. This serves as an update to the last statement released by the ADA in 2005.
The statement contains recommendations for physicians on the overall prevention of diabetic neuropathy, highlighting prevention as a key component because of the lack of treatment to reverse this condition. Other types of diabetic neuropathies are discussed and proposes guidelines on their management and treatment.
Lead author of the statement, Rodica Pop-Busui, MD, PhD, stated, “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.” The statement also intended to clarify the various forms of diabetic neuropathy that exist and present a more objective and easy-to-follow recommendation method.
A classification system describes the 3 main types of diabetic neuropathies: diffuse neuropathy, mononeuropathy, and radiculopathy or polyradiculopathy. Recommendations for overall prevention of diabetic neuropathy include the following:
- In type 1 diabetes, work to effectively control glucose as soon as possible to prevent or delay the development of distal symmetric polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN).
- In type 2 diabetes, work to effectively control glucose to prevent or slow the progression of DSPN.
- With type 2 diabetes, consider a multifactorial approach with targeting glycemia and other risk factors to prevent CAN.
Additional recommendations on screening, diagnosing, managing, and treating the specific forms are also included in the position statement.
Regarding pain management, the researchers recommend the following:
- As the initial approach, consider either pregabalin or duloxetine.
- Gabapentin can also be considered as an effective initial approach, but the patient’s socioeconomic status, comorbidities and potential drug interactions have to be taken into consideration.
- Tricyclic antidepressants are also effective but are not approved by the FDA and should be used with caution because of the higher risk of serious side effects.
- Opioids are not recommended as first- or second-line agents for treating pain associated with DSPN because of the high risks of addiction and other complications.
With overprescribing of narcotics for neuropathic pain on the rise, “treatment of neuropathy pain is specifically relevant,” added Dr. Pop-Busui. “We also demonstrate that there are ways to stay away from prescribing opioids and avoiding the epidemic of addiction and serious health consequences associated with opioid use in patients with diabetes.”
For more information visit care.diabetesjournals.org.