Diabetic peripheral neuropathy (DPN) affects roughly half of patients with long-standing diabetes and is the dominant risk factor for diabetic foot ulceration. That loss of protective sensation is what turns therapeutic footwear and offloading from advice into a necessity.
Common patterns
- Distal symmetric polyneuropathy (most common, stocking-glove pattern)
- Autonomic neuropathy (gastroparesis, orthostatic hypotension)
- Mononeuropathy (median, ulnar, peroneal)
- Diabetic amyotrophy (proximal, often type 2 diabetes)
Bedside diagnosis
- 10 g Semmes-Weinstein monofilament at ten plantar sites
- 128 Hz tuning fork at the hallux
- Pinprick sensation
- Achilles reflex
- Inspection for foot deformity
First-line drug therapy
ADA/AAN evidence supports pregabalin, duloxetine, gabapentin and amitriptyline as first-line agents. Start low, titrate slowly, monitor side-effects. Diabetic neuropathy treatment at Dialine combines these with periodic foot assessment.
References
- Pop-Busui R, et al. Diabetic Neuropathy: ADA Position Statement. Diabetes Care. 2017;40(1):136–154. https://doi.org/10.2337/dc16-2042
- Price R, et al. Painful diabetic polyneuropathy practice guideline. Neurology. 2022;98(1):31–43. https://doi.org/10.1212/WNL.0000000000013038