Prevention and Management Strategies for Diabetic Neuropathy

Abstract

Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed.

Keywords: diabetes; diabetic neuropathy; diagnostic evaluation; distal symmetrical polyneuropathy; footcare; glycemic control; lifestyle modifications; neuromodulation; nutraceuticals; pain management.

Figure 1

Overview of prevention and management strategies for diabetic neuropathy. ALA, α-lipoic acid; ALC, acetyl-l-carnitine; FREMS, frequency-modulated electromagnetic neural stimulation; IV, intravenous; NMES, neuromuscular electrical stimulation; PENS, percutaneous electrical nerve stimulation; SCS, spinal cord stimulation; SNRIs, serotonin and norepinephrine reuptake inhibitors; TCAs, tricyclic antidepressants; TENS, transcutaneous electrical nerve stimulation.