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Diabetisk nevropati

Sist oppdatert: Sist revidert:
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Definisjon: 
Er nerveskade på grunn av diabetes. Vanligst er distal symmetrisk polynevropati og autonom nevropati
Forekomst: 
Prevalens øker med alderen fra 5% tidlig i forløpet til nærmere 50% etter minst 25 år med sykdommen. Noe hyppigere ved type 2 enn ved type 1-diabetes
Symptomer: 
Tidlige symptomer kan være nummenhet, stikking, prikking, brennende/verkende smerte eller ømhet på leggene eller i føttene
Funn: 
Kan være nedsatt følesans, vibrasjonssans, smerte i føttene
Diagnostikk: 
Monofilament-test, vibrasjonssans, ankelrefleks. Ev. nevrografi
Behandling: 
God blodsukkerkontroll. Forebygging og behandling av fotsår. Adekvat smertebehandling + tiltak mot andre risikofaktorer
  1. Helsedirektoratet. Nasjonale faglig retningslinje for diabetes. Oslo; Helsedirektoratet 2016 helsedirektoratet.no  
  2. Malik RA, Alam U, Azmi S. Diabetic neuropathy. BMJ Best Practice, last updated June 2019.
  3. 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  
  4. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol 2012; 11: 521-34. PubMed  
  5. Young M, Boulton A, Williams D et al. A multi-centre study of the prevalence of diabetic neuropathy in patients attending UK diabetic clinics. Diabetologia 1993; 36: 150-4. PubMed  
  6. Pop-Busui R, Sima A, Stevens M. Diabetic neuropathy and oxidative stress. Diabetes Metab Res Rev. 2006;22:257-273. 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. American Diabetes Association. Standards of medical care in diabetes - 2014. Diabetes Care. 2014;37:S14-S80.
  12. Wong MC, et al. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007; 335: 87. British Medical Journal  
  13. Lindsay TJ, Rodgers BC, Savath V, Hettinger K. Treating diabetic peripheral neuropathic pain. Am Fam Physician 2010; 82: 151-8. American Family Physician  
  14. The Diabetes Control and Complications Trial Group. The effect of intensive diabetes therapy on the development and progression of diabetic neuropathy. Ann Intern Med 1995; 122: 562-8. Annals of Internal Medicine  
  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. UK Prospective Diabetes Study (UKPDS) Group. Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-53. PubMed  
  18. American Diabetes Association. Preventive foot care in people with diabetes (position statement). Diabetes Care 2000; 23 (suppl 1): 55-6.
  19. Frykberg RG. Diabetic foot ulcers: pathogenesis and management. Am Fam Physician 2002; 66: 1655-62. American Family Physician  
  20. Arauz-Pacheco C, Parrott MA, Raskin P; American Diabetes Association. Hypertension management in adults with diabetes. Diabetes Care 2004; 27(suppl 1): S65-7.
  21. Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy: systematic review. BMJ 2007; 335: 87. British Medical Journal  
  22. 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  
  23. Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: An umbrella systematic review and comparative effectiveness network meta-analysis. Ann Intern Med 2014; 161: 639-49. doi:10.7326/M14-0511 DOI  
  24. Saarto T, Wiffen PJ. Antidepressants for neuropathic pain. Cochrane Database of Systematic Reviews 2007, Issue 4. Art. No.: CD005454. DOI: 10.1002/14651858.CD005454.pub2. DOI  
  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. Griebeler ML, Morey-Vargas OL, Brito JP, et al. Pharmacologic interventions for painful diabetic neuropathy: an umbrella systematic review and comparative effectiveness network meta-analysis published corrections appear in Ann Intern Med. 2015;162(8):600, and Ann Intern Med. 2015;162(10)739. Ann Intern Med. 2014;161(9):639–649.
  27. Argoff CE, Backonja MM, Belgrade MJ, et al. Consensus guidelines: treatment planning and options. Diabetic peripheral neuropathic pain. Mayo Clin Proc 2006; 81(4 suppl): S12–S25.
  28. Berger A, Dukes E, Edelsberg J, Stacey B, Oster G. Use of tricyclic anti-depressants in older patients with diabetic peripheral neuropathy. Clin J Pain 2007; 23: 251-8. PubMed  
  29. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;1:CD007115. PMID: 24385423 PubMed  
  30. 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  
  31. 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  
  32. Jingxuan L, Litian M, Jianfang F. Different Drugs for the Treatment of Painful Diabetic Peripheral Neuropathy: A Meta-Analysis. Front Neurol. 2021;12:682244. Published 2021 Oct 29. PMID: 34777192 PubMed  
  33. 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  
  34. Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: High-dose monotherapy or their combination? The ``COMBO-DN study`` - a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain 2013. doi:10.1016/j.pain.2013.05.043 DOI  
  35. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD006146. DOI: 10.1002/14651858.CD006146.pub2. DOI  
  36. 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.
  37. 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  
  38. 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  
  39. Nøkleby K, Julsrud Berg T. Diabetisk nevropati - en klinisk oversikt. Tidsskr Nor Lægeforen 2005; 125: 1646-9. PubMed  
  • Terje Johannessen, professor i allmennmedisin, Trondheim

Tidligere fagmedarbeidere

  • Tor Claudi, spesialist i allmennmedisin og indremedisin, Rønvik legesenter, Bodø og NOKLUS-klinikk, Bergen
  • Lino Witte, Dr. med., Arzt in Weiterbildung, innere Medizin, Frankfurt, Tyskland (Deximed.de)