Diabetic Neuropathy: New ADA Position Statement for Primary Care

Dr Pop-Busui: DSPN is the most prevalent form, and the best studied. DSPN is associated with several known severe complications, such as ulcers and infections, which can lead to lower-limb amputations. But even before that, the progressive damage of the various populations of nerve fibers may cause pain and/or lead to progressive loss of sensation, which decreases sense of balance and thermal discrimination; these factors increase the risk for falls or burns and affect patients’ daily function.

In addition to DSPN, the autonomic neuropathies, such as cardiovascular autonomic neuropathy, are relevant to clinical practice. More evidence has been unveiled in the past decade to further underline the seriousness of the consequences of diabetic neuropathies.

Medscape: The position statement emphasizes that the key to treatment of diabetic neuropathy is to prevent it in the first place. Are there any new strategies—beyond the recognized importance of adequate glucose control—that PCPs should be instituting in patients with diabetes or prediabetes?

Dr Busui: Evidence is emerging about the role of lifestyle interventions in the prevention of DSPN, which is quite exciting. A couple of studies show that, especially for patients with prediabetes and neuropathy, exercise and some types of diets seem to have a beneficial effect in prevention and possibly even reversal.[However, we don’t have the same strength of evidence that we have for the benefit of glucose control in type 1 diabetes. These data have to be confirmed, but lifestyle interventions are cited in the statement as promising therapeutic options.

Medscape: What type of exercise? How much exercise is required?

Dr Busui: We cited studies that tested the types of exercise used in the Diabetes Prevention Program: typically 30 minutes daily of moderate to intense exercise.Other studies have looked at more intense exercise, but most studied the level of exercise used in the Diabetes Prevention Program.
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