Approximately every third patient with diabetes is affected by neuropathy, which can significantly impair the quality of life: on the one hand through racking pain and discomfort in the feet, such as tingling, burning and numbness, and on the other hand due to painless wounds. Neuropathy therefore plays a decisive role in the development of diabetic foot syndrome, which often leads to amputations. "But even painful neuropathies often remain undetected and untreated for a long time," explains Prof. Dan Ziegler, Deputy Director at the Institute for Clinical Diabetology of the German Diabetes Centre of the Heinrich Heine University in Dusseldorf, referring to current study results. For example, the PROTECT study showed that 70% of patients with signs of neuropathy did not know that they were affected by it. Even in patients with type 2 diabetes and foot pain, neuropathy was previously unknown in 57% of cases (1). Appropriate therapy is therefore provided at a correspondingly late stage. According to a recent evaluation of the so-called KORA-F4 study, only 38% of neuropathy patients with pain that requires treatment receive pain therapy, while only 6% of people with neuropathies also receive treatment in the form of medication for the underlying nerve damage (2). The international team of experts therefore assessed the disease as "underestimated, underdiagnosed and undertreated".
Simple Clinical Examination
The experts discussed new methods for the early diagnosis of neuropathy, which are already being used in clinical studies and special clinics. These include the determination of nerve fibre density by means of confocal corneal microscopy or skin biopsy, the sudoscan to measure disturbed sweat secretion or the measurement of skin autofluorescence, with which the concentration of advanced glycation end products (AGEs) in the skin can be determined. In the majority of cases, however, simple clinical examinations and neurological tests, such as Rydel-Seiffer's tuning fork vibration testing and examination of the temperature, pain and touch sensation, are sufficient for diagnosis in practice.
Modern Therapy Strategies
According to experts, early diagnosis sets the course for the future development of this serious disease. This is because the sooner it is diagnosed, the better the progression of the nerve damage can be stopped. First and foremost after the clinical diagnosis of DSPN is the modification of lifestyle and the control of cardiovascular and other risk factors. Furthermore, other diseases and possible drug interactions should be considered before initiating symptomatic pain therapy. This is only indicated for painful DSPN. The drug therapy can be supported by non-drug measures such as acupuncture, high tone therapy, physiotherapy and psychotherapy. In addition, painful, asymptomatic and painless DSPN can be treated with active substances such as benfotiamine and alpha lipoic acid, which can intervene in the pathogenesis of the disease and thereby alleviate the symptoms. Last but not least, the endangered feet of neuropathy patients need to be protected, for example by a suitable supply of shoes.
Overall, the experts agreed that more attention should be paid to the disease. Patients should also be sensitised to the discomfort in their feet. Only in this way could all therapeutic options be exhausted at an early stage and serious complications avoided.
International Expert Board “The challenge of timely diagnosis of diabetic sensorimotor polyneuropathy in clinical practice” on the occasion of the EASD Congress on October 2, 2018 in Berlin; organiser: Wörwag Pharma.
1.) Ziegler D et. al: Painful and painless neuropathies are distinct and largely undiagnosed entities in subjects participating in an educational initiative (PROTECT-Study). Diabetes Res Clin Pract. 2018;139:147-154
2.) Meisinger et al.: Neuropathic pain is not adequately treated in the older general population: Results from the KORA F4 survey. Pharmacoepidemiol Drug Saf 2018; 27: 806-814
3.) Thornalley PJ et al. High prevalence of low plasma thiamine concentration in diabetes linked to a marker of vascular disease. Diabetologia 2007; 50: 2164-2170
4.) Schreeb KH et al. Comparative bioavailability of two vitamin B1 preparations: benfotiamine and thiamine mononitrate. Eur J Clin Pharmacol 1997; 52: 319-320