Guidelines for diagnosis and outpatient management of diabetic peripheral neuropathy. European Association for the Study of Diabetes, Neurodiab.

Diabetic peripheral neuropathy is estimated to affect at least 30% of patients with diabetes mellitus. The appropriate management of this disturbance is essential if late-stage complications, such as foot ulceration and amputations, are to be avoided in these patients. The need for improvements in the clinical management of neuropathy in primary and outpatient hospital care resulted in the identification of an international consensus group to address the management of diabetic peripheral neuropathy by the practising clinician. The international consensus group included diabetologists, neurologists, primary care clinicians, diabetes specialist nurses and podiatrists. The outcome of this consensus group was endorsed by the Neurodiab Executive Committee. The International Guidelines describe the recommendations for the management of diabetes in primary care and in outpatient hospital care and include an annual review of diabetic patients. This should include a history of patient symptoms, the type of diabetes, lifestyle and social circumstances. In examination of the foot, the status of the skin (e.g. absence of sweating and presence of ulceration) immobility of joints, gait and footwear should be noted. Simple tests should be performed to assess peripheral sensation, including sensation to pinprick, light touch, vibration, pressure, and ankle reflexes should be checked. It is the objective of the guidelines document to provide clear and simple instructions for the diagnosis and management of neuropathy on an outpatient basis, in particular during annual review of the patient. Adoption of the guidelines should lead to improvements in the management of neuropathy.