Diabetic neuropathies are the most common chronic complications of diabetes, affecting different parts of the nervous system and presenting with diverse clinical manifestations. Early recognition and appropriate management are crucial due to the high prevalence and potential for serious complications. Key points include: 1. **Diabetic Neuropathy as an Exclusion Diagnosis**: Non-diabetic neuropathies may coexist with diabetes and can be treated. 2. **Treatment Options**: Various treatment options are available for symptomatic diabetic neuropathy. 3. **Asymptomatic Neuropathy**: Up to 50% of diabetic peripheral neuropathies may be asymptomatic, increasing the risk of foot injuries. 4. **Autonomic Neuropathy**: Recognition and treatment can improve symptoms, reduce sequelae, and enhance quality of life. **Most Common Forms**: - **Distal Symmetric Polyneuropathy (DSPN)**: The most common form, affecting about 75% of diabetic patients. - **Cardiovascular Autonomic Neuropathy (CAN)**: Affects autonomic neurons and is associated with various symptoms and increased cardiovascular risk. **Prevention**: - **Glucose Control**: Optimizing glucose control is critical for preventing or delaying DSPN and CAN. - **Lifestyle Modifications**: Intensive lifestyle interventions, including exercise and dietary changes, are recommended. **Screening and Diagnosis**: - **DSPN**: Assessment should start at diagnosis of type 2 diabetes and 5 years after type 1 diagnosis, with annual screening thereafter. - **CAN**: Screening for symptoms and signs of autonomic dysfunction is recommended, especially in patients with hypoglycemia unawareness. **Management**: - **DSPN**: Intensive glucose control is effective in preventing DSPN in type 1 diabetes. - **CAN**: Optimization of glucose and blood pressure management is crucial. - **Pain Management**: Medications like pregabalin, duloxetine, and gabapentin are recommended for neuropathic pain. - **Fall Prevention**: Gait and balance assessments may be necessary to evaluate fall risk. **Atypical Neuropathies**: - **Mononeuropathies**: Common in diabetes, often resolving spontaneously. - **Diabetic Radiculoplexus Neuropathy**: Affects the lumbosacral plexus, typically in men with type 2 diabetes. - **Treatment-Induced Neuropathy**: A rare condition caused by abrupt improvement in glycemic control. **Research and Clinical Trials**: - **Endpoints**: Validated clinical instruments and electrophysiological measures are essential for accurate diagnosis and prognosis in trials. This Position Statement emphasizes the importance of early detection, appropriate management, and comprehensive care for diabetic neuropathies.Diabetic neuropathies are the most common chronic complications of diabetes, affecting different parts of the nervous system and presenting with diverse clinical manifestations. Early recognition and appropriate management are crucial due to the high prevalence and potential for serious complications. Key points include: 1. **Diabetic Neuropathy as an Exclusion Diagnosis**: Non-diabetic neuropathies may coexist with diabetes and can be treated. 2. **Treatment Options**: Various treatment options are available for symptomatic diabetic neuropathy. 3. **Asymptomatic Neuropathy**: Up to 50% of diabetic peripheral neuropathies may be asymptomatic, increasing the risk of foot injuries. 4. **Autonomic Neuropathy**: Recognition and treatment can improve symptoms, reduce sequelae, and enhance quality of life. **Most Common Forms**: - **Distal Symmetric Polyneuropathy (DSPN)**: The most common form, affecting about 75% of diabetic patients. - **Cardiovascular Autonomic Neuropathy (CAN)**: Affects autonomic neurons and is associated with various symptoms and increased cardiovascular risk. **Prevention**: - **Glucose Control**: Optimizing glucose control is critical for preventing or delaying DSPN and CAN. - **Lifestyle Modifications**: Intensive lifestyle interventions, including exercise and dietary changes, are recommended. **Screening and Diagnosis**: - **DSPN**: Assessment should start at diagnosis of type 2 diabetes and 5 years after type 1 diagnosis, with annual screening thereafter. - **CAN**: Screening for symptoms and signs of autonomic dysfunction is recommended, especially in patients with hypoglycemia unawareness. **Management**: - **DSPN**: Intensive glucose control is effective in preventing DSPN in type 1 diabetes. - **CAN**: Optimization of glucose and blood pressure management is crucial. - **Pain Management**: Medications like pregabalin, duloxetine, and gabapentin are recommended for neuropathic pain. - **Fall Prevention**: Gait and balance assessments may be necessary to evaluate fall risk. **Atypical Neuropathies**: - **Mononeuropathies**: Common in diabetes, often resolving spontaneously. - **Diabetic Radiculoplexus Neuropathy**: Affects the lumbosacral plexus, typically in men with type 2 diabetes. - **Treatment-Induced Neuropathy**: A rare condition caused by abrupt improvement in glycemic control. **Research and Clinical Trials**: - **Endpoints**: Validated clinical instruments and electrophysiological measures are essential for accurate diagnosis and prognosis in trials. This Position Statement emphasizes the importance of early detection, appropriate management, and comprehensive care for diabetic neuropathies.