Skip to main content
Top

Open Access 26-10-2024 | Prediabetes | Review

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

Authors: Salem A. Beshyah, Amin Jayyousi, Ali Saif Al-Mamari, Ashraf Shaaban, Ebaa Al Ozairi, Jalal Nafach, Mahir Khalil Ibrahim Jallo, Said Khader, Marc Evans

Published in: Diabetes Therapy

Login to get access

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.
Literature
2.
go back to reference Miranda-Massari JR, Gonzalez MJ, Jimenez FJ, Allende-Vigo MZ, Duconge J. Metabolic correction in the management of diabetic peripheral neuropathy: improving clinical results beyond symptom control. Curr Clin Pharmacol. 2011;6(4):260–73.CrossRefPubMedPubMedCentral Miranda-Massari JR, Gonzalez MJ, Jimenez FJ, Allende-Vigo MZ, Duconge J. Metabolic correction in the management of diabetic peripheral neuropathy: improving clinical results beyond symptom control. Curr Clin Pharmacol. 2011;6(4):260–73.CrossRefPubMedPubMedCentral
3.
go back to reference Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11(6):521–34.CrossRefPubMedPubMedCentral Callaghan BC, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11(6):521–34.CrossRefPubMedPubMedCentral
5.
go back to reference Egenolf N, Zu Altenschildesche CM, et al. Diagnosing small fiber neuropathy in clinical practice: a deep phenotyping study. Ther Adv Neurol Disord. 2021;14:17562864211004318.CrossRefPubMedPubMedCentral Egenolf N, Zu Altenschildesche CM, et al. Diagnosing small fiber neuropathy in clinical practice: a deep phenotyping study. Ther Adv Neurol Disord. 2021;14:17562864211004318.CrossRefPubMedPubMedCentral
6.
go back to reference Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain. 2004;5(3):143–9.CrossRefPubMed Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain. 2004;5(3):143–9.CrossRefPubMed
7.
go back to reference American Diabetes Association. Standards of medical care in diabetes—2021 abridged for primary care providers. Clin Diabetes. 2021;39(1):14–43.CrossRef American Diabetes Association. Standards of medical care in diabetes—2021 abridged for primary care providers. Clin Diabetes. 2021;39(1):14–43.CrossRef
8.
go back to reference Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3–22.CrossRefPubMed Ziegler D, Papanas N, Vinik AI, Shaw JE. Epidemiology of polyneuropathy in diabetes and prediabetes. Handb Clin Neurol. 2014;126:3–22.CrossRefPubMed
10.
go back to reference Kumar S, Rao K, Maiya AG, Hande HM, Hazari A. Need for early diabetic peripheral neuropathy screening among public transport professionals—a case report. Laser Ther. 2016;25(2):141–4.CrossRefPubMedPubMedCentral Kumar S, Rao K, Maiya AG, Hande HM, Hazari A. Need for early diabetic peripheral neuropathy screening among public transport professionals—a case report. Laser Ther. 2016;25(2):141–4.CrossRefPubMedPubMedCentral
14.
go back to reference Algeffari MA. Painful diabetic peripheral neuropathy among Saudi diabetic patients is common but under-recognized: multicenter cross-sectional study at primary health care setting. J Fam Community Med. 2018;25(1):43–7.CrossRef Algeffari MA. Painful diabetic peripheral neuropathy among Saudi diabetic patients is common but under-recognized: multicenter cross-sectional study at primary health care setting. J Fam Community Med. 2018;25(1):43–7.CrossRef
15.
go back to reference Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75.CrossRefPubMed Armstrong DG, Boulton AJM, Bus SA. Diabetic foot ulcers and their recurrence. N Engl J Med. 2017;376(24):2367–75.CrossRefPubMed
16.
go back to reference Singh R, Kishore L, Kaur N. Diabetic peripheral neuropathy: current perspective and future directions. Pharmacol Res. 2014;80:21–35.CrossRefPubMed Singh R, Kishore L, Kaur N. Diabetic peripheral neuropathy: current perspective and future directions. Pharmacol Res. 2014;80:21–35.CrossRefPubMed
17.
go back to reference Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998;158(3):289–92.CrossRefPubMed Armstrong DG, Lavery LA, Vela SA, Quebedeaux TL, Fleischli JG. Choosing a practical screening instrument to identify patients at risk for diabetic foot ulceration. Arch Intern Med. 1998;158(3):289–92.CrossRefPubMed
18.
go back to reference Olaleye D, Perkins BA, Bril V. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract. 2001;54(2):115–28.CrossRefPubMed Olaleye D, Perkins BA, Bril V. Evaluation of three screening tests and a risk assessment model for diagnosing peripheral neuropathy in the diabetes clinic. Diabetes Res Clin Pract. 2001;54(2):115–28.CrossRefPubMed
19.
go back to reference Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001;24(2):250–6.CrossRefPubMed Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001;24(2):250–6.CrossRefPubMed
20.
go back to reference Breiner A, Lovblom LE, Perkins BA, Bril V. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes Care. 2014;37(5):1418–24.CrossRefPubMed Breiner A, Lovblom LE, Perkins BA, Bril V. Does the prevailing hypothesis that small-fiber dysfunction precedes large-fiber dysfunction apply to type 1 diabetic patients? Diabetes Care. 2014;37(5):1418–24.CrossRefPubMed
21.
go back to reference Dube S, Hulke SM, Wakode SL, et al. Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests. J Fam Med Prim Care. 2022;11(10):6204–8.CrossRef Dube S, Hulke SM, Wakode SL, et al. Effectiveness of Semmes Weinstein 10 gm monofilament in diabetic peripheral neuropathy taking nerve conduction and autonomic function study as reference tests. J Fam Med Prim Care. 2022;11(10):6204–8.CrossRef
22.
go back to reference McIllhatton A, Lanting S, Lambkin D, Leigh L, Casey S, Chuter V. Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy: a systematic review with meta-analyses. BMJ Open Diabetes Res Care. 2021;9(2): e002528.CrossRefPubMedPubMedCentral McIllhatton A, Lanting S, Lambkin D, Leigh L, Casey S, Chuter V. Reliability of recommended non-invasive chairside screening tests for diabetes-related peripheral neuropathy: a systematic review with meta-analyses. BMJ Open Diabetes Res Care. 2021;9(2): e002528.CrossRefPubMedPubMedCentral
23.
go back to reference Drobek N, Sowa P, Jankowski P, et al. Undiagnosed diabetes and prediabetes in patients with chronic coronary syndromes—an alarming public health issue. J Clin Med. 2021;10(9):1981.CrossRefPubMedPubMedCentral Drobek N, Sowa P, Jankowski P, et al. Undiagnosed diabetes and prediabetes in patients with chronic coronary syndromes—an alarming public health issue. J Clin Med. 2021;10(9):1981.CrossRefPubMedPubMedCentral
33.
go back to reference Bongaerts BWC, Rathmann W, Heier M, et al. Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor polyneuropathy: the KORA F4 study. Diabetes Care. 2013;36(5):1141–6.CrossRefPubMedPubMedCentral Bongaerts BWC, Rathmann W, Heier M, et al. Older subjects with diabetes and prediabetes are frequently unaware of having distal sensorimotor polyneuropathy: the KORA F4 study. Diabetes Care. 2013;36(5):1141–6.CrossRefPubMedPubMedCentral
34.
go back to reference Veresiu AI, Bondor CI, Florea B, Vinik EJ, Vinik AI, Gâvan NA. Detection of undisclosed neuropathy and assessment of its impact on quality of life: a survey in 25,000 Romanian patients with diabetes. J Diabetes Complications. 2015;29(5):644–9.CrossRefPubMed Veresiu AI, Bondor CI, Florea B, Vinik EJ, Vinik AI, Gâvan NA. Detection of undisclosed neuropathy and assessment of its impact on quality of life: a survey in 25,000 Romanian patients with diabetes. J Diabetes Complications. 2015;29(5):644–9.CrossRefPubMed
35.
go back to reference Gad H, Kalra S, Pinzon R, et al. Earlier diagnosis of peripheral neuropathy in primary care: a call to action. J Peripher Nerv Syst JPNS. 2024;29:28–37.CrossRefPubMed Gad H, Kalra S, Pinzon R, et al. Earlier diagnosis of peripheral neuropathy in primary care: a call to action. J Peripher Nerv Syst JPNS. 2024;29:28–37.CrossRefPubMed
36.
go back to reference Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in screening, early diagnosis and accurate staging of diabetic neuropathy. Front Endocrinol. 2021;26(12):671257.CrossRef Carmichael J, Fadavi H, Ishibashi F, Shore AC, Tavakoli M. Advances in screening, early diagnosis and accurate staging of diabetic neuropathy. Front Endocrinol. 2021;26(12):671257.CrossRef
38.
39.
go back to reference Ziegler D, Herder C, Papanas N. Neuropathy in prediabetes. Diabetes Metab Res Rev. 2023;39(8):e3693.CrossRefPubMed Ziegler D, Herder C, Papanas N. Neuropathy in prediabetes. Diabetes Metab Res Rev. 2023;39(8):e3693.CrossRefPubMed
40.
go back to reference Alleman CJM, Westerhout KY, Hensen M, et al. Humanistic and economic burden of painful diabetic peripheral neuropathy in Europe: a review of the literature. Diabetes Res Clin Pract. 2015;109(2):215–25.CrossRefPubMed Alleman CJM, Westerhout KY, Hensen M, et al. Humanistic and economic burden of painful diabetic peripheral neuropathy in Europe: a review of the literature. Diabetes Res Clin Pract. 2015;109(2):215–25.CrossRefPubMed
41.
go back to reference Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRef Diabetes Control and Complications Trial Research Group, Nathan DM, Genuth S, et al. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977–86.CrossRef
42.
43.
44.
go back to reference Smith BH, Torrance N. Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 2012;16(3):191–8.CrossRefPubMed Smith BH, Torrance N. Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 2012;16(3):191–8.CrossRefPubMed
45.
46.
go back to reference American Diabetes Association. 1. Improving care and promoting health in populations: standards of medical care in diabetes—2020. Diabetes Care. 2019;43(Suppl_1):S7-13.CrossRef American Diabetes Association. 1. Improving care and promoting health in populations: standards of medical care in diabetes—2020. Diabetes Care. 2019;43(Suppl_1):S7-13.CrossRef
47.
49.
go back to reference Alharbi TJ, Tourkmani AM, Abdelhay O, et al. The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus. PLoS ONE. 2018;13(10):e0204420.CrossRefPubMedPubMedCentral Alharbi TJ, Tourkmani AM, Abdelhay O, et al. The association of metformin use with vitamin B12 deficiency and peripheral neuropathy in Saudi individuals with type 2 diabetes mellitus. PLoS ONE. 2018;13(10):e0204420.CrossRefPubMedPubMedCentral
53.
go back to reference García-Casares N, González-González G, de la Cruz-Cosme C, et al. Effects of GLP-1 receptor agonists on neurological complications of diabetes. Rev Endocr Metab Disord. 2023;24(4):655–72.CrossRefPubMedPubMedCentral García-Casares N, González-González G, de la Cruz-Cosme C, et al. Effects of GLP-1 receptor agonists on neurological complications of diabetes. Rev Endocr Metab Disord. 2023;24(4):655–72.CrossRefPubMedPubMedCentral
54.
go back to reference Paez-Hurtado AM, Calderon-Ospina CA, Nava-Mesa MO. Mechanisms of action of vitamin B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) in pain: a narrative review. Nutr Neurosci. 2023;26(3):235–53.CrossRefPubMed Paez-Hurtado AM, Calderon-Ospina CA, Nava-Mesa MO. Mechanisms of action of vitamin B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) in pain: a narrative review. Nutr Neurosci. 2023;26(3):235–53.CrossRefPubMed
55.
go back to reference Pinzon RT, Schellack N, Matawaran BJ, et al. Clinical recommendations for the use of neurotropic B vitamins (B1, B6, and B12) for the management of peripheral neuropathy: consensus from a multidisciplinary expert panel. J Assoc Physicians India. 2023;71(7):11–2.PubMed Pinzon RT, Schellack N, Matawaran BJ, et al. Clinical recommendations for the use of neurotropic B vitamins (B1, B6, and B12) for the management of peripheral neuropathy: consensus from a multidisciplinary expert panel. J Assoc Physicians India. 2023;71(7):11–2.PubMed
Metadata
Title
Current Perspectives in Pre- and Diabetic Peripheral Neuropathy Diagnosis and Management: An Expert Statement for the Gulf Region
Authors
Salem A. Beshyah
Amin Jayyousi
Ali Saif Al-Mamari
Ashraf Shaaban
Ebaa Al Ozairi
Jalal Nafach
Mahir Khalil Ibrahim Jallo
Said Khader
Marc Evans
Publication date
26-10-2024
Publisher
Springer Healthcare
Keyword
Prediabetes
Published in
Diabetes Therapy
Print ISSN: 1869-6953
Electronic ISSN: 1869-6961
DOI
https://doi.org/10.1007/s13300-024-01658-8

Keynote webinar | Spotlight on adolescent vaping

  • Live
  • Webinar | 29-01-2025 | 18:00 (CET)

Live: Wednesday 29th January, 18:00-19:30 CET

Growing numbers of young people are using e-cigarettes, despite warnings of respiratory effects and addiction. How can doctors tackle the epidemic, and what health effects should you prepare to manage in your clinics?

Prof. Ann McNeill
Dr. Debbie Robson
Benji Horwell
Developed by: Springer Medicine
Join the webinar

Keynote webinar | Spotlight on modern management of frailty

Frailty has a significant impact on health and wellbeing, especially in older adults. Our experts explain the factors that contribute to the development of frailty and how you can manage the condition and reduce the risk of disability, dependency, and mortality in your patients.

Prof. Alfonso Cruz-Jentoft
Prof. Barbara C. van Munster
Prof. Mirko Petrovic
Developed by: Springer Medicine
Watch now

A quick guide to ECGs

Improve your ECG interpretation skills with this comprehensive, rapid, interactive course. Expert advice provides detailed feedback as you work through 50 ECGs covering the most common cardiac presentations to ensure your practice stays up to date. 

PD Dr. Carsten W. Israel
Developed by: Springer Medizin
Start the cases

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine
Read more