Diabetic sensorimotor polyneuropathy (DSPN) affects around one third of people with
diabetes and accounts for considerable morbidity, increased risk of mortality, reduced
quality of life, and increased health care costs resulting particularly from neuropathic
pain and foot ulcers. Painful DSPN is encountered in 13-26% of diabetes patients,
while up to 50% of patients with DSPN may be asymptomatic. Unfortunately, DSPN still
remains inadequately diagnosed and treated. Herein we provide international expert
consensus recommendations and algorithms for screening, diagnosis, and treatment of
DSPN in clinical practice derived from a Delphi process. Typical neuropathic symptoms
include pain, paresthesias, and numbness particularly in the feet and calves. Clinical
diagnosis of DSPN is based on neuropathic symptoms and signs (deficits). Management
of DSPN includes three cornerstones: 1.) lifestyle modification, optimal diabetes
treatment aimed at near-normoglycemia, and multifactorial cardiovascular risk intervention,
2.) pathogenetically oriented pharmacotherapy (e.g. α-lipoic acid and benfotiamine),
and 3.) symptomatic treatment of neuropathic pain including analgesic pharmacotherapy
(antidepressants, anticonvulsants, opioids, capsaicin 8% patch and combinations, if
required) and non-pharmacological options. Considering the individual risk profile,
pain management should not only aim at pain relief, but also allow for improvement
in quality of sleep, functionality, and general quality of life.
