Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach
The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of t...
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| Published in | Frontiers in endocrinology (Lausanne) Vol. 15; p. 1380929 |
|---|---|
| Main Authors | , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
Frontiers Media S.A
17.06.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1664-2392 1664-2392 |
| DOI | 10.3389/fendo.2024.1380929 |
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| Abstract | The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN. |
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| AbstractList | The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed “screening and diagnostic” algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN. The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed "screening and diagnostic" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed "screening and diagnostic" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN. |
| Author | Sengun, Ihsan Sukru Adas, Mine Sahin, Ibrahim Erdem Tilki, Hacer Atmaca, Aysegul Ketenci, Aysegul Demir, Tevfik Oner, Ramazan Ilyas Soyleli, Hatice |
| AuthorAffiliation | 7 Department of Endocrinology, Prof. Dr. Cemil Tascioglu City Hospital , Istanbul , Türkiye 5 Department of Internal Medicine, Adiyaman University Faculty of Medicine , Adiyaman , Türkiye 2 Department of Physical Medicine and Rehabilitation, Koc University Faculty of Medicine , Istanbul , Türkiye 6 Department of Neurology, Ondokuz Mayis University Faculty of Medicine , Samsun , Türkiye 9 Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine , Izmir , Türkiye 8 Department of Medical Affairs, Abdi Ibrahim Pharmaceuticals , Istanbul , Türkiye 3 Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine , Malatya , Türkiye 1 Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine , Samsun , Türkiye 4 Department of Neurology, Dokuz Eylul University Faculty of Medicine , Izmir , Türkiye |
| AuthorAffiliation_xml | – name: 3 Department of Endocrinology and Metabolism, Inonu University Faculty of Medicine , Malatya , Türkiye – name: 4 Department of Neurology, Dokuz Eylul University Faculty of Medicine , Izmir , Türkiye – name: 5 Department of Internal Medicine, Adiyaman University Faculty of Medicine , Adiyaman , Türkiye – name: 2 Department of Physical Medicine and Rehabilitation, Koc University Faculty of Medicine , Istanbul , Türkiye – name: 9 Department of Endocrinology and Metabolism, Dokuz Eylul University Faculty of Medicine , Izmir , Türkiye – name: 6 Department of Neurology, Ondokuz Mayis University Faculty of Medicine , Samsun , Türkiye – name: 8 Department of Medical Affairs, Abdi Ibrahim Pharmaceuticals , Istanbul , Türkiye – name: 1 Department of Endocrinology and Metabolism, Ondokuz Mayis University Faculty of Medicine , Samsun , Türkiye – name: 7 Department of Endocrinology, Prof. Dr. Cemil Tascioglu City Hospital , Istanbul , Türkiye |
| Author_xml | – sequence: 1 givenname: Aysegul surname: Atmaca fullname: Atmaca, Aysegul – sequence: 2 givenname: Aysegul surname: Ketenci fullname: Ketenci, Aysegul – sequence: 3 givenname: Ibrahim surname: Sahin fullname: Sahin, Ibrahim – sequence: 4 givenname: Ihsan Sukru surname: Sengun fullname: Sengun, Ihsan Sukru – sequence: 5 givenname: Ramazan Ilyas surname: Oner fullname: Oner, Ramazan Ilyas – sequence: 6 givenname: Hacer surname: Erdem Tilki fullname: Erdem Tilki, Hacer – sequence: 7 givenname: Mine surname: Adas fullname: Adas, Mine – sequence: 8 givenname: Hatice surname: Soyleli fullname: Soyleli, Hatice – sequence: 9 givenname: Tevfik surname: Demir fullname: Demir, Tevfik |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/38952393$$D View this record in MEDLINE/PubMed |
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| CitedBy_id | crossref_primary_10_1155_jdr_3661739 crossref_primary_10_3389_fcell_2024_1484329 crossref_primary_10_1186_s13098_025_01621_y crossref_primary_10_3390_app14198726 crossref_primary_10_1016_j_arr_2024_102519 crossref_primary_10_1016_j_diabres_2025_112115 |
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| Copyright | Copyright © 2024 Atmaca, Ketenci, Sahin, Sengun, Oner, Erdem Tilki, Adas, Soyleli and Demir. Copyright © 2024 Atmaca, Ketenci, Sahin, Sengun, Oner, Erdem Tilki, Adas, Soyleli and Demir 2024 Atmaca, Ketenci, Sahin, Sengun, Oner, Erdem Tilki, Adas, Soyleli and Demir |
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| Keywords | clinical diagnosis diabetic peripheral neuropathy pathogenesis screening multidisciplinary approach awareness expert panel pathogenetically-oriented pharmacotherapy |
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| SubjectTerms | awareness Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - diagnosis Diabetes Mellitus, Type 2 - therapy Diabetic Neuropathies - diagnosis Diabetic Neuropathies - therapy diabetic peripheral neuropathy Disease Management Endocrinology expert panel Humans Mass Screening - methods multidisciplinary approach pathogenesis screening |
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| Title | Expert opinion on screening, diagnosis and management of diabetic peripheral neuropathy: a multidisciplinary approach |
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