Pathways in the Diagnosis and Management of Diabetic Polyneuropathy

Pathways in the Diagnosis and Management of Diabetic Polyneuropathy

Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of t...

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Main Authors: Kaku, Michelle, Vinik, Aaron, Simpson, David M.
Format: Online
Language:English
Published: Springer US 2015
Online Access:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440893/
id pubmed-4440893
recordtype oai_dc
spelling pubmed-44408932015-05-27 Pathways in the Diagnosis and Management of Diabetic Polyneuropathy Kaku, Michelle Vinik, Aaron Simpson, David M. Pharmacologic Treatment of Type 2 Diabetes (HE Lebovitz and G Bahtiyar, Section Editors) Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of typical patient pathways in DSPN, and highlights variations in diagnosis, management, and referral patterns among different providers. DSPN is managed in several settings by primary care physicians (PCPs), specialists, and nurse practitioners. The initial clinical management of the patient is often dependent on the presenting complaint, the referral pattern of the provider, level of comfort of the PCP in managing diabetic complications, and geographic access to specialists. The primary treatment of DSPN focuses mainly on glycemic control and adjustment of modifiable risk factors, but other causes of neuropathy should also be investigated. Several pharmacologic agents are recommended by treatment guidelines, and as DSPN typically exists with comorbid conditions, a multimodal therapeutic approach should be considered. Barriers to effective management include failure to recognize DSPN, and misdiagnosis. Patient education also remains important. Referral patterns vary widely according to geographic location, access to services, provider preferences, and comfort in managing complex aspects of the disease. The variability in patient pathways affects patient education, satisfaction, and outcomes. Standardized screening tools, a multidisciplinary team approach, and treatment algorithms for diabetic neuropathy should improve future care. To improve patient outcomes, DSPN needs to be diagnosed sooner and interventions made before significant nerve damage occurs. Springer US 2015-04-22 2015 /pmc/articles/PMC4440893/ /pubmed/25899758 http://dx.doi.org/10.1007/s11892-015-0609-2 Text en © The Author(s) 2015 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.
repository_type Open Access Journal
institution_category Foreign Institution
institution US National Center for Biotechnology Information
building NCBI PubMed
collection Online Access
language English
format Online
author Kaku, Michelle
Vinik, Aaron
Simpson, David M.
spellingShingle Kaku, Michelle
Vinik, Aaron
Simpson, David M.
Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
author_facet Kaku, Michelle
Vinik, Aaron
Simpson, David M.
author_sort Kaku, Michelle
title Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
title_short Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
title_full Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
title_fullStr Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
title_full_unstemmed Pathways in the Diagnosis and Management of Diabetic Polyneuropathy
title_sort pathways in the diagnosis and management of diabetic polyneuropathy
description Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability. The management of DSPN can be frustrating for both patient and physician. This article provides a general overview of typical patient pathways in DSPN, and highlights variations in diagnosis, management, and referral patterns among different providers. DSPN is managed in several settings by primary care physicians (PCPs), specialists, and nurse practitioners. The initial clinical management of the patient is often dependent on the presenting complaint, the referral pattern of the provider, level of comfort of the PCP in managing diabetic complications, and geographic access to specialists. The primary treatment of DSPN focuses mainly on glycemic control and adjustment of modifiable risk factors, but other causes of neuropathy should also be investigated. Several pharmacologic agents are recommended by treatment guidelines, and as DSPN typically exists with comorbid conditions, a multimodal therapeutic approach should be considered. Barriers to effective management include failure to recognize DSPN, and misdiagnosis. Patient education also remains important. Referral patterns vary widely according to geographic location, access to services, provider preferences, and comfort in managing complex aspects of the disease. The variability in patient pathways affects patient education, satisfaction, and outcomes. Standardized screening tools, a multidisciplinary team approach, and treatment algorithms for diabetic neuropathy should improve future care. To improve patient outcomes, DSPN needs to be diagnosed sooner and interventions made before significant nerve damage occurs.
publisher Springer US
publishDate 2015
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4440893/
_version_ 1613226792765620224

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