Remy Waardenburg

specialist i allmänmedicin

Björn Eliasson

adjungerad professor och överläkare

--&gt; https://bestpractice.bmj.com

Malik RA, Alam U, Azmi S. Diabetic neuropathy. BMJ Best Practice, last updated June 2019.

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=31197153[uid]

Feldman EL, Callaghan BC, Pop-Busui R, et al. Diabetic neuropathy. Nat Rev Dis Primers 2019; 5(1): 41. pmid:31197153

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=22608666[uid]

Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012; 11: 521-34. PMID:22608666.

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=Diabetes Care[ta]+AND+40[vol]+AND+136[page]

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.

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=21852677[uid]

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

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=24144652[uid]

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

--&gt; http://search.aafp.org/search?client=aafp&amp;site=aafp&amp;output=xml_no_dtd&amp;proxystylesheet=aafp&amp;num=10&amp;as_epq=Treating painful diabetic peripheral neuropathy: an update

Snyder MJ, Gibbs LM. Treating painful diabetic peripheral neuropathy: an update. Am Fam Physician 2016; 94: 227-34.

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.

Vinik A, Maser R, Mitchell B et al. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553-79.

Chu NV, Edelman SV. Erectile dysfunction and diabetes. Curr Diab Rep 2002; 2: 60-6.

--&gt; https://www.diabeteshandboken.se/inneh%C3%A5ll/30.-nervsystemet-neuropati-13755343

Diabeteshandboken.se. Nervsystemet neuropati. 2015-12-15 (Hämtad 2019-11-07).

--&gt; https://webbutik.skl.se/bilder/artiklar/pdf/7585-689-6.pdf

Sveriges Kommuner och Landsting. Fotundersökning vid diabetes. Nationellt vårdprogram för prevention av fotkomplikationer vid diabetes. Maj 2018 (Hämtad 2019-11-07).

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=27389526[uid]

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

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=30705493[uid]

American Diabetes Association. Standards of Medical Care in Diabetes-2019 Abridged for Primary Care Providers. Clin Diabetes 2019; 37(1): 11-34. pmid:30705493

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.

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.

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=29064042[uid]

Gibbons CH. Treatment-Induced Neuropathy of Diabetes. Curr Diab Rep 2017; 17(12): 127. pmid:29064042

Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007; 335: 87.

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.

--&gt; https://www.sbu.se/sv/publikationer/SBU-utvarderar/lakemedelsbehandling-av-vanliga-smarttillstand-hos-aldre-personer/

SBU. Läkemedelsbehandling av vanliga smärttillstånd hos äldre personer. 2020-09-03 (Hämtad 2020-09-15).

Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010; 82: 151-8.

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.

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.

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.

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.

--&gt; http://dx.doi.org/10.1212/WNL.0000000000003882

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

--&gt; http://dx.doi.org/10.1002/14651858.CD007076.pub3

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

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.

Mason L, Moore RA, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ 2004; 328: 991.

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=27746370[uid]

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

--&gt; http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Search&amp;db=PubMed&amp;term=28267267[uid]

Stino AM, Smith AG. Peripheral neuropathy in prediabetes and the metabolic syndrome. J Diabetes Investig 2017; 8(5): 646-655. pmid:28267267

Nervskador som senkomplikation till diabetes, oftast i benen. 

Upp till 50 % av personer med diabetes utvecklar diabetesneuropati.

Vanligast är symmetriska smärtor, dysestestier och minskad känsel (hypestesi).

Nedsatt känsel (monofilament, temperatur, vibrationssinne). Smärta vid beröring. 

Anamnes och klinisk undersökning är viktigast. I vissa fall kan provtagning och andra undersökningar övervägas. 

God metabol kontroll. Smärtbehandling med antidepressiva och antiepileptika i första hand. 

Basfakta

Definition

Förekomst

Etiologi och patogenes

Predisponerande faktorer

ICD-10

ICD-10 Primärvård

Olika typer av diabetesneuropati

Distal symmetrisk polyneuropati

Autonom neuropati

Den neuropatiska foten

Reversibla neuropatier

Diagnos

Diagnoskriterier

Differentialdiagnoser

Anamnes

Kliniska fynd

Kompletterande undersökningar i primärvården

Andra undersökningar

När remittera?

Behandling

Nationella riktlinjer

Behandlingsmål

Behandlingen i korthet

Intensiv glukoskontroll

Egenvård

Läkemedelsbehandling

Behandling av autonom neuropati

Annan behandling

Förebyggande åtgärder

Förlopp, komplikationer och prognos

Förlopp

Komplikationer

Prognos

Uppföljning

Plan

Vad bör kontrolleras?

Patientinformation

Skriftlig patientinformation

Animationer

Källor

Referenser

Sakkunniga

Tidigare sakkunniga