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Diabetesneuropati

Senast uppdaterad: Senast reviderad:
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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  3. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012; 11: 521-34. PMID:22608666. PubMed  
  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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  8. Garces-Sanchez M, Laughlin RS, Dyck PJ, et al. Painless diabetic motor neuropathy: A variant of diabetic lumbosacral radiculoplexus neuropathy?. Ann Neurol 2011; 69: 1043-54. 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  
  15. Larsen J, Sjoholm H, Hanssen K et al. Optimal blood glucose control during 18 years preserves peripheral nerve function in patients with 30 years' duration of type 1 diabetes. Diabetes Care 2003; 26: 2400-4. PubMed  
  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. Tesfaye S, Sloan G, Petrie J, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet 2022. pmid:36007534 PubMed  
  21. SBU. Läkemedelsbehandling av vanliga smärttillstånd hos äldre personer. 2020-09-03 (Hämtad 2020-09-15). www.sbu.se  
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  23. 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  
  24. 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  
  25. 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  
  26. 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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  28. 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  
  29. 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.
  30. 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  
  31. 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  
  32. 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