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KEY POINTS

KEY POINTS

  • Diabetic peripheral neuropathy is the most common type of peripheral neuropathy.

  • Control of the underlying condition (ie, diabetes) may help slow the progression of diabetic peripheral neuropathy.

  • Multiple medications can be used throughout the course of therapy for diabetic peripheral neuropathy.

  • Medication therapy management (MTM) providers should work with the patient and prescribers to ensure that medications for diabetic peripheral neuropathy are properly titrated to symptom relief.

  • MTM providers should educate patients regarding the importance of proper foot care.

INTRODUCTION

According to the International Association for the Study of Pain (IASP), neuropathic pain is defined as pain arising as a direct consequence of a lesion or disease affecting the somatosensory system.1 Peripheral neuropathy specifically describes damage to the peripheral nervous system. The nerve damage can cause changes in pain perception, enhanced sensory transmission, nerve structure reorganization, and loss of pain inhibition.2

Causes of Peripheral Neuropathy

Several different disease states and conditions have been known to cause peripheral neuropathy (Table 32-1).3 Of those, diabetic peripheral neuropathy (DPN) is the most common. Estimates of the incidence and prevalence of DPN vary greatly; DPN may occur in 20% of those with long-standing type 1 diabetes and up to 50% of those with type 2 diabetes.4 Risk factors associated with the development of DPN include poor glucose control, hypertension, dyslipidemia, height (as a proxy for nerve length), smoking, and obesity.4 The remainder of this chapter will focus on DPN.

TABLE 32-1Types of Peripheral Neuropathy

Complications of Diabetic Peripheral Neuropathy

If left untreated or suboptimally treated, DPN can lead to serious and debilitating complications such as foot ulceration, lower limb amputation, Charcot neuroarthropathy, falls, and fractures.4 It is estimated that 15% of all patients with diabetes will develop a foot ulcer during their lifetime; 60% to 70% of foot ulcers are attributed to DPN.5 Ulcers can further be associated with cellulitis, osteomyelitis, or severe nonhealing infections that can lead to amputation of a toe, foot, or leg.5 Risk factors for the development of ulcer complications include poor glycemic control, history of previous ulcers/amputations, poor foot hygiene and care, concurrent peripheral vascular disease, decreased sensitivity, and lack of education.5 In general, the cost of treating DPN and associated complications averages $10.91 billion annually.6

Therapeutic Goals for Diabetic Peripheral Neuropathy

Control and relief of painful symptoms is the primary therapeutic goal in the management of DPN.4 Prevention of foot ulcerations, falls, and ...

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