Selecting a Treatment Regimen
Diabetic Retinopathy
ÎÎAt the time of diagnosis, patients with T2DM should be referred to
an experienced ophthalmologist or optometrist for annual dilated eye
examination (D-4).
ÎÎIn patients with T1DM, a referral should be made within 5 years of
diagnosis (B-2).
ÎÎOptimal glucose, blood pressure, and lipid control should be
implemented to slow the progression of retinopathy (D-4).
ÎÎWomen who are pregnant and have DM should be referred for
frequent/repeated eye examinations during pregnancy and 1 year
postpartum (C-3).
ÎÎPatients with active retinopathy should have examinations more
frequently than once a year, as should patients receiving vascular
endothelial growth factor therapy (D-4).
Diabetic Neuropathy
ÎÎDiabetic painful neuropathy is diagnosed clinically and must be
differentiated from other painful conditions (D-4).
ÎÎInterventions that reduce oxidative stress, improve glycemic control,
and/or improve dyslipidemia and hypertension might have a beneficial
effect on diabetic neuropathy (A-1).
ÎÎExercise and balance training may also be beneficial (C-3).
ÎÎTricyclic antidepressants, anticonvulsants, and serotonin and
norepinephrine reuptake inhibitors are useful treatments (A-1).
ÎLarge-fiber neuropathies are managed with strength, gait, and balance
Î
training; pain management; orthotics to treat and prevent foot deformities;
tendon lengthening for pes equinus from Achilles tendon shortening;
and/or surgical reconstruction and full contact casting as needed (A-1).
ÎÎSmall-fiber neuropathies are managed with foot protection (eg, padded
socks), supportive shoes with orthotics if necessary, regular foot and
shoe inspection, prevention of heat injury, and use of emollient creams.
However, for pain management, medications must be used (A-1).
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