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. 2015 Jun;15(6):609.
doi: 10.1007/s11892-015-0609-2.

Pathways in the Diagnosis and Management of Diabetic Polyneuropathy

Free PMC article

Pathways in the Diagnosis and Management of Diabetic Polyneuropathy

Michelle Kaku et al. Curr Diab Rep. .
Free PMC article


Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of typical patient pathways in DSPN, and highlights variations in diagnosis, management, and referral patterns among different providers. DSPN is managed in several settings by primary care physicians (PCPs), specialists, and nurse practitioners. The initial clinical management of the patient is often dependent on the presenting complaint, the referral pattern of the provider, level of comfort of the PCP in managing diabetic complications, and geographic access to specialists. The primary treatment of DSPN focuses mainly on glycemic control and adjustment of modifiable risk factors, but other causes of neuropathy should also be investigated. Several pharmacologic agents are recommended by treatment guidelines, and as DSPN typically exists with comorbid conditions, a multimodal therapeutic approach should be considered. Barriers to effective management include failure to recognize DSPN, and misdiagnosis. Patient education also remains important. Referral patterns vary widely according to geographic location, access to services, provider preferences, and comfort in managing complex aspects of the disease. The variability in patient pathways affects patient education, satisfaction, and outcomes. Standardized screening tools, a multidisciplinary team approach, and treatment algorithms for diabetic neuropathy should improve future care. To improve patient outcomes, DSPN needs to be diagnosed sooner and interventions made before significant nerve damage occurs.


Fig. 1
Fig. 1
Neuropathic pain pathway adapted from the UK National Institute for Health and Care Excellence [106]
Fig. 2
Fig. 2
Multidisciplinary team approach to the management of diabetic neuropathic pain/distal symmetric polyneuropathy. PCP—primary care physician

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