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| July 26, 2006 |
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| The physicians and staff of The Neuroscience Group are providing this physician and provider communication to help you stay abreast of issues and updates in the dynamic field of neurosciences, with the goal of helping you provide better overall healthcare services to your patients. |
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Identifying and Treating Diabetic Neuropathy
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| One of the most common complications of diabetes is neuropathy. The lifetime prevalence is reported to be between 25% and 50% in persons with diabetes. An increasing number of patients and providers are eagerly seeking ways to address peripheral neuropathy. A range of treatment options is being presented to consumers via the media. Evidence-based practice guidelines have been released by the American Academy of Neurology (AAN) regarding the utility of surgical decompression for the treatment of diabetic neuropathy. |
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| Treatment Options |
| Primary prevention and treatment for diabetic neuropathy rests on managing glucose levels. Treatment of pain related to peripheral neuropathy includes tricyclic antidepressants, SSRIs, anticonvulsants such as gabapentin, phenytoin, lamotrigine and zonisamide, opioids, NSAIDS and tramadol. Capsaicin ointment is used for reducing neuropathy pain. Surgical decompression at the site of anatomic narrowing is being promoted as another treatment option for diabetic neuropathy. Chaudhry, et al, 2005 present an in-depth review of the utility of surgical decompression for the treatment of diabetic neuropathy. |
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The AAN recently released a guideline on the use of surgical decompression for treatment of diabetic neuropathy and noted that there is inadequate evidence on the efficacy of the treatment.
The guideline, which is published in the June 27 issue of Neurology, states that the treatment is unproven, given current knowledge. The guideline is a practice advisory, which presents evidence-based practice recommendations for emerging and newly approved therapies or technologies. |
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| Current evidence supporting decompressive surgery for treating diabetic neuropathy is not sufficient to support or refute the benefits of decompressive surgery. None of the studies reviewed provided either randomization or control group comparison for efficacy. Standard testing parameters, such as distal weakness, DTR’s, gait and Romberg testing were not included in the studies reviewed. The conclusion is that there is inadequate data concerning the efficacy of decompressive surgery for the treatment of diabetic neuropathy. |
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| Public interest in the topic and its controversial nature motivated the development of the guideline. A systematic review of the literature revealed only Class IV studies on the treatment, which is the lowest class of evidence and includes uncontrolled studies and case series. |
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| You can read and download the full guideline [ http://www.aan.com/go/?web=688.900148 ] and summaries to share with your colleagues [ http://www.aan.com/go/?web=689.900148 ] and your patients [ http://www.aan.com/go/?web=690.900148 ]. © 2006 American Academy of Neurology. |
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