Polyneuropathy is inadequately treated despite increasing symptom intensity in individuals with and without diabetes (PROTECT follow‐up study)

Abstract

Aims/Introduction Despite its major clinical impact, distal symmetric polyneuropathy remains frequently undiagnosed and undertreated in clinical practice. We previously reported in the PROTECT Study that 70% of type 2 diabetes patients with distal symmetric polyneuropathy were unaware of having the latter condition. Materials and Methods In the present follow up after 2.5 ± 0.7 years, 122 and 85 participants with and without type 2 diabetes, respectively, completed questionnaires to obtain information about the further course of disease and its management. Results At follow up, 49 and 48% of the respondents with type 2 diabetes and without diabetes, respectively, reported that the intensity of paresthesia or numbness in the feet increased, whereas for burning and pain in the feet the corresponding percentages were 56 and 61%. However, 33 and 40% of the respondents with type 2 diabetes and without diabetes, respectively, reporting neuropathic symptoms at follow up did not receive any pharmacotherapy. Pharmacotherapy of neuropathic symptoms at follow up among participants with type 2 diabetes and without diabetes included mainly World Health Organization Step 1 analgesics (17% each; excluding acetylsalicylic acid), pregabalin/gabapentin (20 and 12%), vitamin B complex (13 and 22%), benfotiamine (13 and 2%), opioids (7 and 12%), antidepressants (4 and 5%) and α‐lipoic acid (4 and 2%). Conclusions These findings point to insufficient care, inadequate treatment adherence or limited efficacy of treatments in patients with polyneuropathy, suggesting that effective measures should be implemented to correct these healthcare deficits.

Epidemiology of major lower extremity amputations in individuals with diabetes in Austria, 2014–2017: A retrospective analysis of health insurance database

“…Approximately 85% of LEA occur as a complication of diabetic foot ulcer (DFU), which is mainly caused by inadequate glucose control, peripheral artery disease, infection management, and polyneuropathy [7][8][9][10]. Evidence shows that a significant proportion of LEA in individuals with diabetes can be prevented by implementing effective multidisciplinary and multisectoral diabetes care programs [11].…”

The complex association between pain and neuropathy

“…However, in a longitudinal study over a 14‐y follow‐up period, the number of patients with polyneuropathy experiencing pain increased with time from 37% to 47% 18 . Moreover, Ziegler et al found that over a 2.5‐y follow‐up period about half the patients with polyneuropathy experience increasing sensory symptoms and pain 19 . In addition, in a longitudinal follow‐up study of patients with small fiber neuropathy, with an average follow‐up duration after diagnosis of 6.2 y, 86.1% noted pain at the initial visit, and 84.2% at the final visit 20 .…”

Stellenwert klinischer, funktioneller und bildgebender Diagnostik zur Früherkennung, Differenzialdiagnose und Verlaufskontrolle diabetischer Neuropathien

“…Autonome Komplikationen wie die diabetische Gastroparese führen neben einer beeinträchtigten Nahrungsaufnahme zu verlängerten Wirklatenzen oral eingenommener Medikamente. Deafferenzierung und vaskuläre Fehlregulation begünstigen (postoperative) Wundheilungsstörungen bis hin zur Amputationsbedürftigkeit, und stumme Myokardinfarkte können zu spät erkannt und somit zu lange unbehandelt bleiben [7,8]. Umso wichtiger ist es, dass Diabetiker regelmäßig auf Neuropathiezeichen hin untersucht werden.…”

“…Leichtgradige Paresen, die nur in einer gezielten neurologischen Untersuchung auffallen, könnten bei vielen Betroffenen aber unerkannt sein. In allen Stadien sind neuropathische Schmerzen ein behandlungsbedürftiges Leitsymptom [8,18]. Diese sind auf eine Schädigung der C-und AδNervenfasern zurückzuführen, die nicht nur zusammen mit einer Large Fiber Polyneuropathie, sondern auch bei einer reinen Small Fiber Neuropathie auftreten kann [11,19].…”