Selecting a Treatment Regimen Diabetic Retinopathy
ÎAt the time of diagnosis, patients with T2DM should be referred to an experienced ophthalmologist or optometrist for annual dilated eye examination (D-4).
ÎIn patients with T1DM, a referral should be made within 5 years of diagnosis (B-2).
ÎOptimal glucose, blood pressure, and lipid control should be implemented to slow the progression of retinopathy (D-4).
ÎWomen who are pregnant and have DM should be referred for frequent/repeated eye examinations during pregnancy and 1 year postpartum (C-3).
ÎPatients 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
ÎDiabetic painful neuropathy is diagnosed clinically and must be differentiated from other painful conditions (D-4).
ÎInterventions that reduce oxidative stress, improve glycemic control, and/or improve dyslipidemia and hypertension might have a beneficial effect on diabetic neuropathy (A-1).
ÎExercise and balance training may also be beneficial (C-3).
ÎTricyclic antidepressants, anticonvulsants, and serotonin and norepinephrine reuptake inhibitors are useful treatments (A-1).
ÎLarge-fiber neuropathies are managed with strength, gait, and balance 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).
ÎSmall-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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