Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations

Dan Ziegler, Solomon Tesfaye, Vincenza Spallone, Irina Gurieva, Juma Al Kaabi, Boris Mankovsky, Emil Martinka, Gabriela Radulian, Khue Thy Nguyen, Alin O. Stirban, Tsvetalina Tankova, Tamás Varkonyi, Roy Freeman, Péter Kempler, Andrew JM Boulton

Research output: Contribution to journalReview articlepeer-review

62 Citations (Scopus)


Diabetic sensorimotor polyneuropathy (DSPN) affects around one third of people with diabetes and accounts for considerable morbidity, increased risk of mortality, reduced quality of life, and increased health care costs resulting particularly from neuropathic pain and foot ulcers. Painful DSPN is encountered in 13–26% of diabetes patients, while up to 50% of patients with DSPN may be asymptomatic. Unfortunately, DSPN still remains inadequately diagnosed and treated. Herein we provide international expert consensus recommendations and algorithms for screening, diagnosis, and treatment of DSPN in clinical practice derived from a Delphi process. Typical neuropathic symptoms include pain, paresthesias, and numbness particularly in the feet and calves. Clinical diagnosis of DSPN is based on neuropathic symptoms and signs (deficits). Management of DSPN includes three cornerstones: (1) lifestyle modification, optimal diabetes treatment aimed at near-normoglycemia, and multifactorial cardiovascular risk intervention, (2) pathogenetically oriented pharmacotherapy (e.g. α-lipoic acid and benfotiamine), and (3) symptomatic treatment of neuropathic pain including analgesic pharmacotherapy (antidepressants, anticonvulsants, opioids, capsaicin 8% patch and combinations, if required) and non-pharmacological options. Considering the individual risk profile, pain management should not only aim at pain relief, but also allow for improvement in quality of sleep, functionality, and general quality of life.

Original languageEnglish
Article number109063
JournalDiabetes Research and Clinical Practice
Publication statusPublished - Apr 2022


  • Diabetic polyneuropathy
  • Diagnosis
  • Guidelines
  • Neuropathic pain
  • Screening
  • Treatment

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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