Distal diabetic neuropathy: review of evidence-based recommendations

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Abstract

Distal diabetic neuropathy is the leading neurological complication of type 2 diabetes. Diabetic neuropathy is heterogeneous in its clinical entity and the pattern of peripheral neural system damage. In most cases the diagnosis is based on the typical neurological symptoms, the results of neurological examination and neurophysiological testing, where available. Medical treatment of pain in distal diabetic neuropathy includes symptomatic and pathogenetic medications. Effective control of diabetes is crucial for reduction of risk of neuropathy progression and is a predictive factor of effective symptomatic and pathogenetic treatment. The primary choice of medication is based on patient’s characteristics, diabetes control, pain severity, concomitant diseases and commercial availability of medications.

 

About the authors

V. B. Beregovsky

Federal Medical Research Center

Author for correspondence.
Email: Vnkh2009@yandex.ru
Россия, St. Petersburg

V. N. Khramilin

Pirogov Russian National Research Medical University

Email: Vnkh2009@yandex.ru
Россия, Moscow

I. Yu. Demidova

Sechenov First Moscow State Medical University

Email: Vnkh2009@yandex.ru
Россия, Moscow

I. A. Strokov

Federal Medical-Social Expertise Agency

Email: Vnkh2009@yandex.ru
Россия, Moscow

I. V. Guryeva

Russian Medical Academy of Postgraduate Education

Email: Vnkh2009@yandex.ru
Россия, Moscow

References

  1. Бреговский В.Б., Посохина О.В., Карпова И.А. Предикторы эффективности лечения диабетической полинейропатии нижних конечностей альфа-липоевой кислотой. Терапевтич. архив. 2005; 10: 15–19.
  2. Дедов И.И., Шестакова М.В. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Издание 6-е, 2013.
  3. Сунцов Ю.И., Дедов И.И., Шестакова М.В. Скрининг осложнений сахарного диабета как метод оценки качества лечебной помощи больным. М., 2008.
  4. Храмилин В.Н., Демидова И.Ю., Игнатова О.Ю. Оценка эффективности различных режимов пероральной терапии альфа-липоевой кислотой болевой формы диабетической периферической полинейропатии. Сахарный диабет № 2. 2010: 3–7.
  5. Хуторная О.Е., Бреговский В.Б., Демина А.Г., Карпова И.А. Частота выявления диабетической полиневропатии нижних конечностей у больных сахарным диабетом в Санкт-Петербурге. Ученые записки СПбГМУ имени И.П. Павлова. 2013; XX (2): 59–61.
  6. Abad F., Diaz-Gomez N.M., Rodriguez I. et al. Subclinical pain and thermal sensory dysfunction in children and adolescents with type 1 diabetes mellitus. Diabet Med. , 2002; 19: 827–831
  7. Abbott C., Carrington A., Ashe H. et al. North-West Diabetes Foot Care Study. The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community based patient cohort. Diabet. Med. 2002; 19: 377–384.
  8. Airey M., Bennett C., Nicolucci A., Williams R. Aldose reductase inhibitors for the prevention and treatment of diabetic peripheral neuropathy. Cochrane Database Syst Rev 2:CD002182, 2000.
  9. American Diabetes Association and American Academy of Neurology. Report and recommendations of the San Antonio conference on diabetic neuropathy (Consensus Statement). Diabetes Care 1988; 11:592–597.
  10. Ametov A.S., Barinov A., Dyck P.J. et al. The Sensory Symptoms of Diabetic Polyneuropathy Are Improved With α-Lipoic Acid (The SYDNEY Trial). Diabetes Care 2003; 26:770–776,
  11. Amthor K.F., Dahl-Jorgensen K., Berg T.J. et al. The effect of 8 years of strict glycaemia control on peripheral nerve function in IDDM patients:the Oslo Study. Diabetologia 1994; 37: 579–784.
  12. Arezzo J.C., Zotova E. Electrophysiologic measures of diabetic neuropathy: mechanism and meaning. International Rev Neurobiol. 2002;50: 229–255.
  13. Arezzo J.C: The use of electrophysiology for the assessment of diabetic neuropathy. Neurosci Res Comm. 1997; 21: 13–22.
  14. Attal N., Cruccu G., Haanpaa M. et al. EFNS guidelines on pharmacological treatment of neuropathic pain.Eur J Neurol 2006; 13:1153–1169.
  15. Boulton A.J., Gries F.A., Jervell J.A. Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med.1998; 15: 508–514.
  16. Boulton A.J., Malik R.A., Arezzo J.C., Sosenko J.M. Diabetic somatic neuropathies. Diabetes Care 2004; 27: 1458–1486.
  17. Boulton A.J., Kubrusly D.B., Bowker J.H. et al. Impaired vibratory perception and diabetic foot ulceration. Diabet Med. 1986;3: 335–337.
  18. Boulton A.J., Vinik A.I., Arezzo J.C. American Diabetes Association. Diabetic neuropathies: a statement by the American Diabetes Association.DiabetesCare 2005; 28: 956–962.
  19. Bril V., England J., Franklin G.M. et al. Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2011; 76: 1.
  20. Bril V. Electrophysiologic testing. In Textbook of Diabetic Neuropathy. Gries FA, Cameron NE, Low PA, Ziegler D, Eds. Stuttgart, Thieme, 2003: 177–184.
  21. Catherine L. Martin et al. Neuropathy Among the Diabetes Control and Complications Trial Cohort 8 Years After Trial Completion. Diab. Care 2006; 29 (2): 340–344.
  22. Cohen H.W., Gibson G., Alderman M. Excess risk of myocardial infarction in patients treated with antidepressant medications: association with use of tricyclic agents. American Journal of Medicine 2000; 108:2–8(7).
  23. Coppini D.V., Wellmer A., Weng C. et al. The natural history of diabetic peripheral neuropathy determined by a 12 year prospective study using vibration perception thresholds. J Clin Neurosci 2001; 8: 520–524.
  24. Cruccu G., Anand P., Attal N. et al. TS.EFNS guidelines on neuropathic pain assessment. Eur J Neurol 2004; Mar;11: 153–162.
  25. Davies M., Brophy S., Williams R., Taylor A. The Prevalence, Severity, and Impact of Painful Diabetic Peripheral Neuropathy in Type 2 Diabetes Diabetes Care 2006; 29: 1518–1522.
  26. DCCT (The Diabetes Control and Complications Trial Research Group).The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. NEnglJMed. 1993; 329: 977–986.
  27. DCCT Research Group: The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Int Med 1995; 122: 561–568.
  28. Dyck P.J., Albers J., Andersen H. et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. – 2011; 27: 620–628.
  29. Dyck P.J., Davies J.L., Clark V.M. et al. Modeling chronic glycemic exposure variables as correlates and predictors of microvascular complications of diabetes. Diabetes Care 2006; 29: 2282–2288.
  30. Dyck P.J., Davies J.L., Litchy W.J. et al: Longitudinal assessment of diabetic polyneuropathy using a composite score in the Rochester Diabetic Neuropathy Study cohort. Neurology 1997; 49: 229–239.
  31. Dyck P.J., Davies J.L., Wilson D.M. et al. Risk factors for severity of diabetic polyneuropathy: intensive longitudinal assessment of the Rochester Diabetic Neuropathy Study cohort. Diabetes Care 1999; 22: 1479–1486.
  32. Dyck P.J., Karnes J.L., O’Brien P.C. et al. The Rochester Diabetic Neuropathy Study: reassessment of tests and criteria for diagnosis and staged severity. Neurol 1992; 42: 1164–1170.
  33. Dyck P.J., Kratz K.M., Karnes J.L. et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 1993; 43: 817–824.
  34. Dyck P.J., Norell J., Tritshler H. et al. Challenges in design of multicenter trials. End points assessed longitudinally for change and monotonicity. Diabetes Care 2007; 30: 2619–2625.
  35. Dyck P.J., O’Brien P.C. Quantitative sensation testing in epidemiological and therapeutic studies of peripheral neuropathy. Muscle Nerve 1999; 22: 659–662.
  36. Dyck P.J. Severity and staging of diabetic polyneuropathy. In Textbook of Diabetic Neuropathy. Gries FA, Cameron NE, Low PA, Ziegler D, Eds. Stuttgart, Thieme, 2003; 170–175.
  37. Ellenberg M. Diabetic neuropathic cachexia. Diabetes. 1974; 23: 418–421.
  38. England JD, Gronseth GS, Franklin G et al. American Academy of Neurology, American Association of Electrodiagnostic Medicine, American Academy of Physical Medicine and Rehabilitation. Distal symmetric polyneuropathy: a definition for clinical research: report of the American Academy of Neurology, the American Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology 2005; 64: 199–207.
  39. Fedele D., Comi G., Coscelli C. et al. A multicenter study on the prevalence of diabetic neuropathy in Italy. Diabetes Care, 20 (5): 836–843.
  40. Franklin G.M., Kahn L.B., Baxter J. et al. Sensory neuropathy in noninsulin-dependent diabetes mellitus. Am J Epidemiol 1990; 131:633–643.
  41. Franklin G.M., Shetterly S.M., Cohen J.A. et al. Risk factors for distal symmetric neuropathy in NIDDM. Diabetes Care 1994; 17: 1172–1177.
  42. Gelber D.A., Pfeifer M.A., Broadstone V.L. Components of variance for vibratory and thermal thresholds testing in normal and diabetic subjects. J Diabetes Complications 1995; 9: 170–176.
  43. Gerr F., Letz R. Covariates of human peripheral function: vibrotactile and thermal thresholds. II. Neurotoxicol Teratol 1994; 16: 105–112.
  44. Hirai A., Yasuda H., Joko M. et al. Evaluation of diabetic neuropathy through the quantitation of cutaneous nerves. J Neurolog Sci 2000; 172:55–62.
  45. International Conceunsus on the Diabetic Foot. DFSG.1999.
  46. International Consensus on the Diabetic Foot & Practical Guidelines on the Management and Prevention of the Diabetic Foot. IWGDF. 2007.
  47. Kastenbauer T., Sauseng S., Sokol G. et al. A prospective study of predictors for foot ulceration in type 2 diabetes. J AmPodiatr Med Assoc 2001; 91: 343–350.
  48. Manes Ch., Papazoglou N. et al. Prevalence of Diabetic Neuropathy and Foot Ulceration: Identification of Potential Risk Factors–A Population-Based Study. Wounds Volume 2002; 14: 11–15.
  49. Martina I., van Koningsveld R., Schmitz P. et al. Measuring vibration threshold with a graduated tuning fork in normal aging and in patients with polyneuropathy J. Neurol. Neurosurg. Psychiatry 1998; 65:743–747.
  50. Maser R.E., Steenkiste A.R., Dorman J.S. et al. Epidemiological correlates of diabetic neuropathy: report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 1989; 38: 1456–1461.
  51. Melton L.J., Dyck P.J. Clinical features of the diabetic neuropathies epidemiology. In: Dyck P. J., Thomas P. K., Asbury A. K., et al, eds. Diabetic neuropathy. Philadelphia: WB Saunders 1987; 27–35.
  52. Melton L.J., Dyck P.J. Epidemiology. In Diabetic Neuropathy. 2nd ed. Dyck PJ, Thomas PK, Eds. Philadelphia, W.B. Saunders, 1999; 239–278.
  53. Muller-Felber W., Landgraf R., Scheuer R. et al. Diabetic neuropathy 3 years after successful pancreas and kidney transplantation. Diabetes 1993; 42: 1482–1486.
  54. NICE clinical guideline. Neuropathic pain – pharmacological Management. Issued: November 2013. NICE clinical guideline 173. guidance.nice.org.uk/cg173
  55. Oyibo S., Prasad Y., Jackson N. et al. The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Diabet Med. 2002; 19: 870–873.
  56. Padua L., Saponara C., Ghirlanda R. et al. Lower limb nerve impairment in diabetic patients: multiperspective assessment. Eur J Neurol 2002; 9: 69–73.
  57. Partanen J., Niskanen L., Lehtinen J., Mervaala E. et al. Natural history of peripheral neuropathy in patients with non-insulin dependent diabetes. New Engl J Med 1995; 333: 39–84.
  58. Pfeifer M., Schumer M. Clinical trials of diabetic neuropathy: past, present, and future Diabetes 1995; 44: 1355–1361.
  59. Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973. DiabetesCare.1978;1: 168–188.
  60. Polydefkis M., Hauer P., Griffin J.W., McArthur J.C. Skin biopsy as a tool to assess distal small fiber innervation in diabetic neuropathy. Diabet Technol Ther 2001; 3: 23–28.
  61. Quattrini C., Tavakoli M., Jeziorska M. et al. Surrogate markers of small fiber damage in human diabetic neuropathy. Diabetes 2007; 56:2148–2154.
  62. Ruhnau K.J., Meissner H.P., Finn J.R. et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med 1999; 16: 1040–1043.
  63. Sima A.A.F., Brown M.B., Prashar A. et al. The reproducibility and sensitivity of sural nerve morphometry in the assessment of diabetic peripheral neuropathy. Diabetologia 1992; 35: 560–569.
  64. Sima A.A.F. Diabetic neuropathy: the utility of nerve biopsy. Electroencephalog Clin Neurophysiol Suppl 1999; 50: 525–533.
  65. Sorensen L., Molyneaux L., Yue D.K. Insensate versus painful diabetic neuropathy: the effects of height, gender, ethnicity and glycaemiccontrol. Diabetes Res Clin Pract 2002; 57: 45–51.
  66. Tesfaye S, Chaturvedi N, Eaton SE, Ward JD, Manes C, IonescuTirgoviste C, Witte DR, Fuller JH, EURODIAB Prospective Complications Study Group. Vascular risk factors and diabetic neuropathy. N Engl J Med 2005;352:341–350
  67. Tesfaye S., Stevens L.K., Stephenson J.M. et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: The EURODIAB IDDM Complications Study. Diabetologia 1996; 39: 1377–1384.
  68. Tesfaye S. et al. Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care 2010; 33: 2285–2293.
  69. Tesfaye S. et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev 2011; 27: 629–638.
  70. Thomas P.K. Nerve biopsy. Diabet Med 1997; 16: 351–352.
  71. Tkac I., Bril V. Glycemic control is related to the electrophysiologic severity of diabetic peripheral sensorimotor polyneuropathy. Diabetes Care 1998; 21: 1749–1752.
  72. Treede R.D., JensenT.S., Campbell J.N. Cruccu Getal. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008; 70: 1630–1635.
  73. UKPDS: Intensive blood glucose with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. Lancet 1998; 352: 837–853.
  74. Vinik A.I., Suwanwalaikorn S., Stansberry K.B. et al. Quantitative measurement of cutaneous perception in diabetic neuropathy. Muscle Nerve. 1995; 18: 574–584.
  75. Young M.J., Boulton A.J.M., MacLeod A.F. et al. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 1993; 36: 150–154.
  76. Young M.J., Breddy J.L., Veves A., Boulton A.J.M. The prediction of diabetic foot ulceration using vibration perception thresholds: a prospective study. Diabetes Care 1994; 17: 557–560.
  77. Zaslansky R., Tarnitsky D. Clinical applications of quantitative sensory testing (QST). J Neurol Sci 1998; 153: 215–238.
  78. Ziegler D., Ametov A., Barinov A. et al. Oral Treatment With α-Lipoic Acid Improves Symptomatic Diabetic Polyneuropathy (The SYDNEY 2 trial) Diabetes Care 2006; 29: 2365–2370.
  79. Ziegler D., Gries F.A., Spuler M., Lessmann F. The epidemiology of diabetic neuropathy: DiaCAN Multicenter Study Group. Diabet Med 10 1993; (Suppl. 2): 82S– 86S.
  80. Ziegler D., Hanefeld M., Ruhnau K.J. et al. Treatment of symptomatic diabetic peripheral neuropathy with the anti- oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia 1995; 38: 1425–1433.
  81. Ziegler D., Hanefeld M., Ruhnau K.J. et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care 1999; 22: 1296–1301.
  82. Ziegler D. Painful Diabetic Neuropathy. Advantage of novel drugs over old drugs? Diabetes Care, 32, SUPP. 2, Nov. 2009: S414–419.
  83. Ziegler D., Low P., Litchy W. et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care 2011; 34: 2054–2060.

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Copyright (c) 2015 Beregovsky V.B., Khramilin V.N., Demidova I.Y., Strokov I.A., Guryeva I.V.

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