neuropathy

ADA: Screening and Prevention of Diabetic Neuropathies

The American Diabetes Association has released a new statement alerting physicians of screening measures and preventative steps for diabetic neuropathies.

The new statement updates the ADA’s 2005 statement on diabetic neuropathy and is based upon data from several recent technical reviews.
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Among the recommendations:

  • Optimize glucose control to prevent or delay development of distal symmetric polyneuropathy (DSPN) in individuals with type 2 diabetes
  • Assessments for DSPN should start at diagnosis of type 2 diabetes, or 5 years after diagnosis of type 1 diabetes, and be performed at least once a year.  
  • Assessment should include a careful history and either temperature or pinprick sensation and vibration sensation using a 128-Hz tuning fork, and all patients should have an annual 10-g monofilament testing to assess for feet at risk for ulceration and amputation.
  • Assessments for cardiovascular autonomic neuropathy (CAN) should be conducted in patients with hypoglycemia unawareness, or in patients with microvascular and neuropathic complications.
  • Tests that exclude other comorbidities, drug effects, or drug interactions should be performed to rule out other factors that mimic CAN in patients with symptoms.

In addition, the report includes overviews of approved medications, pain management and prevention recommendations, treatment of foot complications, and other neuropathies.

“Due to a lack of treatments that target the underlying nerve damage, prevention is the key component of diabetes care. Screening for symptoms and signs of diabetic neuropathy is also critical in clinical practice, as it may detect the earliest stages of neuropathy, enabling early intervention,” the authors wrote.

—Melissa Weiss

Reference:

Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care 40 (1): 136-154. doi: 10.2337/dc16-2042.