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Review
. 2024 Dec;15(12):2455-2474.
doi: 10.1007/s13300-024-01658-8. Epub 2024 Oct 26.

Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region

Affiliations
Review

Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region

Salem A Beshyah et al. Diabetes Ther. 2024 Dec.

Abstract

Peripheral neuropathy (PN) significantly impacts the quality of life, causing substantial morbidity and increased mortality, as well as escalating healthcare costs. While PN can have various causes, the most common form, diabetic peripheral neuropathy, poses considerable risks for potential complications. Diabetic peripheral neuropathy (DPN) affects over 50% of people with prediabetes and diabetes. Despite its prevalence, a global gap in diagnosis and management exists, exacerbated by the COVID-19 pandemic. This expert consensus was formulated through a comprehensive evaluation by a panel of experts, informed by a focused literature review, aiming to establish a clinically robust approach to diagnosing and managing pre- and diabetic PN with the early utilization of neurotropic B vitamins. This document offers a consensus perspective on the existing challenges in diagnosing and managing PN, focusing on DPN. The expert panel proposes measures to address this underdiagnosed burden, highlighting the importance of early intervention through innovative screening methods, integrated care approaches, and therapeutic strategies. The document advocates for increased awareness, targeted campaigns, and proactive care strategies to bridge gaps in the patient care of individuals with diabetes, emphasizing the importance of early detection and timely management to improve overall health outcomes. Specific recommendations include incorporating simplified questionnaires and innovative screening methods into routine care, prioritizing neurotropic B vitamin supplementation, optimizing glucagon-like peptide 1 (GLP-1) receptor agonist treatments, and adopting a holistic approach to neuropathy management. The consensus underscores the urgent need to address the underdiagnosis and undertreatment of PN, offering practical measures to enhance early detection and improve health outcomes for individuals with DPN.

Keywords: Diabetes; Early detection; Expert statement; Neurotropic B vitamins; Peripheral neuropathy; Prediabetes; Screening; Vitamin B.

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Conflict of interest statement

Declarations Conflict of Interest Marc Evans is an Editor-in-Chief of Diabetes Therapy. Marc Evans was not involved in the selection of peer reviewers for the manuscript nor any of the subsequent editorial decisions. Salem A. Beshyah, Amin Jayyousi, Ali Saif Al-Mamari, Ashraf Shaaban, Ebaa Al Ozairi, Jalal Nafach, Mahir Khalil Ibrahim Jallo, and Said Khader declare that they have no competing interests. Ethical Approval This article is based on previously conducted studies and does not contain new studies with human participants or animals performed by any of the authors.

Figures

Fig. 1
Fig. 1
Patient-led questionnaire—screening for peripheral neuropathy. Taken from Gad H, Kalra S, Pinzon R, Gracia RAN, Yotsombut K, Coetzee A, et al. Earlier diagnosis of peripheral neuropathy in primary care: a call to action. J Peripher Nerv Syst JPNS. 2024 Jan 24; Permission to publish was obtained from the copyright holder
Fig. 2
Fig. 2
Physician-led questionnaire—confirmation of peripheral neuropathy diagnosis. Taken from Gad H, Kalra S, Pinzon R, Gracia RAN, Yotsombut K, Coetzee A, et al. Earlier diagnosis of peripheral neuropathy in primary care: a call to action. J Peripher Nerv Syst JPNS. 2024 Jan 24; Permission to publish was obtained from the copyright holder
Fig. 3
Fig. 3
Flowchart for optimizing referral of patients with diabetes: a comprehensive flowchart for primary care physicians
Fig. 4
Fig. 4
Flowchart guiding neuropathy screening and management for at-risk individuals with assessment of vitamin B levels. IM intramuscular. Disclaimer: vitamins B1, B6, and B12 have been shown to have good safety profiles and may be considered for patients, especially those at high risk of peripheral neuropathy

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