"Expert Consensus on Diagnosis and Treatment of Diabetic Neuropathy (2021 Edition)" released!

Diabetic neuropathy is the most common chronic complication of diabetes.
Experts from the Neurological Complications Group of the Diabetes Branch of the Chinese Medical Association wrote the "Expert Consensus on Diabetic Neuropathy (2021 Edition)", which mainly introduced the epidemic of diabetic neuropathy Study, pathogenesis, classification, screening and diagnosis, prevention and treatment, and give tips on important parts
.

Screening and diagnosis 1.
Patients with type 2 diabetes (T2DM) should be screened for distal symmetry polyneuropathy (DSPN) at the time of diagnosis, and patients with type 1 diabetes (T1DM) should be screened for distal symmetry polyneuropathy (DSPN) at least 5 years after diagnosis.
Receive screening once a year
.

(B) 2.
Pre-diabetic patients with symptoms of peripheral neuropathy should be included in the screening
.

(B) 3.
The evaluation should include detailed medical history collection, temperature sensation, acupuncture sensation test (small fiber nerve function), and 128 Hz tuning fork vibration test (large fiber nerve function)
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All patients should be checked with 10 g monofilament nylon wire every year to assess whether there is a risk of foot ulcers and amputation
.

(B) 4.
When the clinical manifestations are atypical, the diagnosis is unknown, or other causes are suspected, it is recommended that the patient go to a neurology specialist or undergo neuroelectrophysiological examination and evaluation
.

Atypical clinical manifestations include: motor symptoms are heavier than sensory symptoms, rapid progress of the disease, and asymmetric lesions
.

(B) Autonomic neuropathy 1.
Diabetic patients with microangiopathy and neurological complications should be evaluated for the symptoms and signs of cardiac autonomic neuropathy (CAN)
.

(E) 2.
When symptoms or signs of CAN appear, other comorbidities or drug effects that may cause CAN symptoms should be excluded
.

(E) 3.
For patients with asymptomatic hypoglycemia, CAN symptoms or signs should be evaluated
.

(C) Gastrointestinal autonomic neuropathy 1.
Patients with diabetic neuropathy, diabetic retinopathy and/or diabetic nephropathy should be evaluated for gastroparesis, and whether there are unexpected blood glucose fluctuations and after eating Symptoms of early fullness, bloating, nausea and vomiting
.

(C) 2.
Before conducting a special gastroparesis test, it is necessary to rule out other known reasons for altering gastric emptying, such as the use of opioids, or glucagon-like peptide-1 receptor agonists and organic substances Obstruction of the gastric discharge tract caused by sexual disease, the latter requires special inspection
.

(C) 3.
The following methods can be used to evaluate gastroparesis: within 4 hours after eating digestible solid food, scintigraphy scans every 15 minutes to assess gastric emptying; or 13C-caprylic acid breath test
.

(B) Autonomic neuropathy of the genitourinary tract 1.
Patients with diabetes should be asked about their libido and their ability to achieve and maintain an erection every year to screen for male erectile dysfunction
.

(C) 2.
Diabetic patients with recurrent urinary tract infections should be evaluated for symptoms such as nocturia, pain during intercourse, etc.
, to screen for symptoms of lower urinary tract irritation and female sexual dysfunction and other forms of diabetic neuropathy
.

(E) Prevention and treatment 1.
Actively control blood glucose in patients with T1DM as early as possible to prevent or delay the occurrence and development of DSPN and CAN
.

(A) 2.
T2DM patients should actively control blood sugar to prevent and delay the occurrence and development of DSPN
.

(B) 3.
For T2DM patients with more advanced disease, multiple risk factors and comorbidities, a single intensive blood glucose control has limited effect on the prevention of DSPN, and the goal should be patient-centered comprehensive management
.

(B) 4.
For T2DM patients with multiple risk factors, comprehensive management of blood glucose control goals should be formulated to prevent the occurrence and development of CAN
.

(C) 5.
In patients with prediabetes, metabolic syndrome and T2DM, life>
.

(B) 6.
Life>
.

(C) Treatment of painful DSPN 1.
To treat diabetic neuropathic pain, pregabalin or duloxetine should be considered first
.

(A) 2.
Taking into account the patient's socioeconomic situation, comorbidities and potential drug interactions, gabapentin can also be used as an effective initial treatment
.

(B) 3.
Tricyclic antidepressants can also effectively relieve neuropathic pain in diabetic patients, but they have a higher risk of serious adverse reactions, so they should be used with caution
.

(B) 4.
In view of the high risk of addiction and other complications, opioids, including tapentadol and tramadol, are not recommended as first-line or second-line drugs for the treatment of DSPN-related pain
.

(E) The above content is extracted from: Neurological Complications Group of Diabetes Branch of Chinese Medical Association.
Expert consensus on diagnosis and treatment of diabetic neuropathy (2021 edition) [J].
Chinese Journal of Diabetes, 2021, 13(6):540-557.