Painful diabetic polyneuropathy: evidence-based diagnosis and treatment

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OBJECTIVE

To analyze the modern methods of diagnosis and treatment of diabetic polyneuropathy (DPN).

MATERIAL AND METHODS

We searched and analyzed clinical studies, meta-analyses, systematic reviews and guidelines for the diagnosis and treatment of painful DPN. Searching included MEDLINE, ELibrary, PubMed, Web of Science, Google Scholar and Clinical key databases over 20 years. Manuscripts with historical interest were also included.

RESULTS

There were 181 manuscripts. DPN can develop not only in diabetes, but also in patients with prediabetes that expands the indications for screening. Primary diagnosis of DPN implies analysis of anamnesis, complaints, temperature and/or pain sensitivity, vibration and tactile sensitivity. This diagnosis is sufficient for most patients. If differential diagnosis is necessary in complex cases, one can use ENMG, confocal microscopy, assessment of epidermal density of nerve endings and quantitative sensory tests. TCA (Amitriptyline), duloxetine, pregabalin, gabapentin and thioctic acid are recommended for painful DPN. The choice of drugs is based on patient risk profile and potential adverse reactions. Evaluation of efficacy and safety of painful DPN treatment is required. Ineffective therapy requires replacement of drugs and/or combination of medications.

CONCLUSION

The use of the proposed algorithms will make it possible to objectify the diagnosis and improve the quality of medical care in patients with DPN.

Keywords:

diabetes mellitus

diabetic polyneuropathy

diagnosis of diabetic polyneuropathy

treatment of painful diabetic polyneuropathy

Authors:

Khramilin V.N.

Pirogov Russian National Research Medical University

Davydov O.S.

Research Institute of General Pathology and Pathophysiology

Received:

05.10.2021

Accepted:

06.10.2021

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