Gå direkt till huvudinnehållet

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. 
  1. Malik RA, Alam U, Azmi S. Diabetic neuropathy. BMJ Best Practice, last updated June 2019. bestpractice.bmj.com  
  2. Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers 2019; 5(1): 41. pmid:31197153 PubMed  
  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  
  6. Jaiswal M, Lauer A, Martin CL, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36(12): 3903-8. pmid:24144652 PubMed  
  7. Snyder MJ, Gibbs LM. Treating painful diabetic peripheral neuropathy: an update. Am Fam Physician 2016; 94: 227-34. American Family Physician  
  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  
  9. Vinik A, Maser R, Mitchell B et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553-79. PubMed  
  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  
  13. Bril V, Blanchette CM, Noone JM, et al. The dilemma of diabetes in chronic inflammatory demyelinating polyneuropathy. J Diabetes Complications 2016; 30(7): 1401-7. pmid:27389526 PubMed  
  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. 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.
  26. Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. Neurology 2017. doi:10.1212/WNL.0000000000003882 DOI  
  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