Abstract
The diabetic neuropathies are heterogenous, affecting sensorimotor as well as autonomic nerves. Chronic sensorimotor distal symmetric polyneuropathy is the most common with various range of clinical features from severe sensory symptoms to asymptomatic forms.
Motoric and autonomic dysfunction may be present. One must consider nondiabetic neuropathies particularly in presence of unusual clinical symptoms.
Pathogenesis of diabetic neuropathy is multifactorial. Oxidative stress in poor metabolic controlled diabetics with chronic hyperglycemia and dyslipidemia leads to nervous system disorders and vasculopathy caused by metabolic dysfunction as well.
Presence of neuropathic pain typical for small fiber damage could occure already in prediabetes and early diabetes, electromyographic findings could be without pathology in that case. Quality of life as well as patient's mental state are potentially affected by presence of chronic pain.
Diabetics with asymptomatic neuropathy are at high risk of diabetic foot ulcer development. Considering recommendations, annually screening for distal polyneuropathy as well as appropriate foot care education is required in all diabetic patients.
Management of neuropathic pain diagnostics and treatment is multidisciplinar. The pharmacotherapy of pain itself is complicated and, besides aim for optimal glycemic control, with emphasis on symptomatic treatments.
Three lines of symptomatic pharmaceutics are determined in local guidelines with recommendation on first line agent start. Comorbidities must be respected and gradual titration of drug dosage is recommended to minimalise side effects.
Internationally respected American Diabetes Association Standard of medical care appoints especially pregabalin and duloxetine for the first line treatment. In cases of severe pain, combinations of certain agents and nonpharmacological treatment including psychotherapeutic procedures should be considered.