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Diabetesneuropati

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Sakkunnig:

Definition:
Nervskador som senkomplikation till diabetes, oftast i benen. 
Förekomst:
Upp till 50 % av personer med diabetes utvecklar diabetesneuropati.
Symtom:
Vanligast är symmetriska smärtor, dysestestier och minskad känsel (hypestesi).
Kliniska fynd:
Nedsatt känsel (monofilament, temperatur, vibrationssinne). Smärta vid beröring. 
Diagnostik:
Anamnes och klinisk undersökning är viktigast. I vissa fall kan provtagning och andra undersökningar övervägas. 
Behandling:
God metabol kontroll. Smärtbehandling med antidepressiva och antiepileptika i första hand. 
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  4. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-54. PubMed  
  5. Abbott CA, Malik RA, van Ross ER, et al. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K.. Diabetes Care 2011; 34(10): 2220-4. pmid:21852677 PubMed  
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  10. Chu NV, Edelman SV. Erectile dysfunction and diabetes. Curr Diab Rep 2002; 2: 60-6. PubMed  
  11. Diabeteshandboken.se. Nervsystemet neuropati. 2015-12-15 (Hämtad 2019-11-07). www.diabeteshandboken.se  
  12. Sveriges Kommuner och Landsting. Fotundersökning vid diabetes. Nationellt vårdprogram för prevention av fotkomplikationer vid diabetes. Maj 2018 (Hämtad 2019-11-07). webbutik.skl.se  
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  14. American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes 2019; 37(1): 11-34. pmid:30705493 PubMed  
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  16. Larsen J, Sjoholm H, Berg T et al. Eighteen years of fair glycemic control preserves cardiac autonomic function in type 1 diabetes. Diabetes Care 2004; 27: 963-6. PubMed  
  17. Gibbons CH. Treatment-Induced Neuropathy of Diabetes. Curr Diab Rep 2017; 17(12): 127. pmid:29064042 PubMed  
  18. Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007; 335: 87. British Medical Journal  
  19. Sultan A, Gaskell H, Derry S, Moore RA. Duloxetine for painful diabetic neuropathy and fibromyalgia pain: systematic review of randomised trials. BMC Neurol 2008; 8: 29. PubMed  
  20. SBU. Läkemedelsbehandling av vanliga smärttillstånd hos äldre personer. 2020-09-03 (Hämtad 2020-09-15). www.sbu.se  
  21. Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010; 82: 151-8. American Family Physician  
  22. Kaur H, Hota D, Bhansali H, et al. A comparative evaluation of amitriptyline and duloxetine in painful diabetic neuropathy: A randomized, double-blind, cross-over clinical trial. Diabetes Care 2011; 34: 818-22. PubMed  
  23. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014 Jan 3;1:CD007115. DOI: 10.1002/14651858.CD007115.pub3. DOI  
  24. Ko SH, Kwon HS, Yu JM, et al. Comparison of the efficacy and safety of tramadol/acetaminophen combination therapy and gabapentin in the treatment of painful diabetic neuropathy. Diabet Med 2010; 27: 1033-40. PubMed  
  25. Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J Diabetes Complications. 2015;29(1):146–156.
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  27. Derry S, Bell RF, Straube S, et al. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019;1(1):CD007076. Published 2019 Jan 23. doi:10.1002/14651858.CD007076.pub3 DOI  
  28. Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37(8):2302–2309.
  29. Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004; 328: 991. British Medical Journal  
  30. Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. J Pain. 2017; 18: 42-53. PMID: 27746370 PubMed  
  31. Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. J Diabetes Investig 2017; 8(5): 646-655. pmid:28267267 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas

Tidigare sakkunniga

  • Björn Eliasson, adjungerad professor och överläkare, Diabetescentrum, Sahlgrenska universitetssjukhuset, Göteborg