Diabetic peripheral neuropathy affects up to 50% of older type 2 diabetic patients. Whereas some patients may have extremely painful symptoms, others with a more marked neuropathic deficit may be asymptomatic. Diagnosis requires careful examination of the lower limbs. Management involves establishing that the neuropathy is caused by diabetes instead of more sinister causes and aiming for optimal glycemic control. Medications, usually tricyclic drugs or anticonvulsant agents, may be required. Patients with peripheral neuropathy must be considered at risk of insensate foot ulceration and must receive preventive education and podiatric care.
Andrew J.M. Boulton, MD, DSc(Hon), FRCP, is a professor of medicine at the University of Manchester, U.K., and the University of Miami in Miami, Fla.
Note of disclosure: Dr. Boulton has received honoraria for speaking engagements or consulting fees from Pfizer and Eli Lilly. These companies manufacture drugs for treatment of neuropathic pain.
- American Diabetes Association