DIAGNOSIS AND RATIONAL TREATMENT OF PAINFUL DIABETIC PERIPHERAL NEUROPATHY: AN INTERDISCIPLINARY EXPERT CONSENSUS

被引:0
作者
Galstya, Gagik R. [1 ]
Starostina, Elena G. [2 ]
Yakhno, Nikolay N. [3 ]
Gurieva, Irina, V [4 ]
Churukanov, Maxim, V [3 ]
Strokov, Igor A. [3 ]
Tokmakova, Alla Y. [1 ]
Kukushkin, Mikhail L. [5 ]
Martynov, Anatoly, I [6 ]
Shestakova, Marina, V [1 ]
机构
[1] Endocrinol Res Ctr, Moscow, Russia
[2] Moscow Reg Res & Clin Inst, Moscow, Russia
[3] IM Sechenov First Moscow State Med Univ, Moscow, Russia
[4] Russian Med Acad Continuous Profess Educ, Moscow, Russia
[5] Res Inst Gen Pathol & Pathophysiol, Moscow, Russia
[6] AI Evdokimov Moscow State Med Stomatol Univ, Moscow, Russia
来源
DIABETES MELLITUS | 2019年 / 22卷 / 04期
关键词
diabetes mellitus; diabetic peripheral neuropathy; painful neuropathy; neuropathic pain; diagnosis; treatment; GENERAL-POPULATION; NATURAL-HISTORY; PREVALENCE; IMPACT; COMPLICATIONS; INTERVENTION; STATEMENT; MELLITUS; PEOPLE; ASSOCIATION;
D O I
10.14341/DM9625
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Diabetic peripheral neuropathy is a common chronic complication of diabetes mellitus, significantly impairing well-being, quality of life and functioning of patients. The prevalence of diabetic peripheral neuropathy in the Russian Federation ranges from 0.1% to 67.2% in type 1 and from 0.1 to 42.4% in type 2 diabetes mellitus. However, based on the large-scale epidemiological studies, the true prevalence of diabetic peripheral neuropathy is much higher (50 to 70%), with its painful variant occurring in 16% to 30% of patients. Despite the fact that diabetic peripheral neuropathy remains the most common chronic complication of diabetes mellitus, its diagnosis and therapy leave much to be desired. To optimize diagnostic and treatment approaches to painful diabetic peripheral neuropathy, a group of experts representing the leading Russian professional medical associations has developed clinical guidelines for the diagnosis and rational therapy of patients with painful diabetic peripheral neuropathy. This document presents practical aspects of the clinical diagnosis of painful diabetic peripheral neuropathy and an algorithm for differential diagnosis of pain in the lower extremities in patients with diabetes mellitus. The use of symptomatic analgesics with central action, such as anticonvulsants, antidepressants and opioids, is based on the main aspects of neuropathic pain pathophysiology. The characteristics of each drug class are given, with consideration of evidence on their efficacy, tolerability, and the possibility of combination therapy. The data on the first, second, and third lines of agents is presented in accordance with several international clinical guidelines. The need for a tailored drug choice, taking into account the evidence-based data on their efficacy and safety, concomitant drug therapy, tolerability, cost and preferences of the patient, age of the patient and concomitant disorders, is emphasized.
引用
收藏
页码:305 / 327
页数:23
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