What Primary Care Practitioners Need to Know About Diabetic Neuropathy

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Peripheral Diabetic Neuropathy (DSPN) is the most common cause of foot ulcers — a key factor for amputation. The National Institute of Diabetes and Digestive and Kidney Diseases estimates neuropathy affects 60 to 70 percent of persons with diabetes in some form. DSPN often gets missed until it’s too late, contributing to the fact that one in four people with diabetes have a lifetime risk of amputation.

Charles Pascale, a Medicare beneficiary, had no personal experience with diabetes until the mid-1990s when he developed a pins and needles feeling in his feet. 

My previous primary care doctor was not taking charge of my diabetes. As far as I know, it wasn’t on my primary caregiver’s checklist to look at blood sugar levels regularly or do a full foot exam,” he said.

After about 15 years of trying to manage his diabetes with his primary care physician, Charles started seeing an endocrinologist and received his first foot exam. Now he is more informed about his condition and is better equipped to manage it. He currently sits on the Quality Insights Quality Innovation Network’s Everyone with Diabetes Counts Advisory Committee in New Jersey and is working to raise awareness of the need for proper foot care, including exams, among other Medicare beneficiaries.

DSPN often gets missed until it’s too late, contributing to the fact that one in four people with diabetes have a lifetime risk of amputation. 

According to the latest ADA position statement on diabetic neuropathy, early recognition and appropriate management of neuropathies in patients with diabetes are important for three main reasons:

  1. It’s a diagnosis of exclusion.” Diabetic neuropathy is often considered only after other conditions have been ruled out, which can delay treatment.
  2. It’s common, but symptoms aren’t always apparent. DSPN affects the extremities — toes, feet, legs, fingers and hands. But, up to 50 percent of DSPN cases may be asymptomatic. If it’s not recognized, and if preventive foot care is not implemented, patients are at risk for injuries to their feet.
  3. It can be treated. There are a number of treatment options from various drug classes — antidepressants, anticonvulsants, analgesics, topical agents and non-medicinal interventions. Not all medications work for everyone, and side effects must be considered, so it is important to work closely with a clinician to find the right treatment.

Exams are essential to good foot care. An annual diabetic foot exam should be done on all persons with Type 2 Diabetes starting at diagnosis, and on all persons with Type 1 of five years duration.

Click here to learn more about exams and foot care and CMS' Everyone with Diabetes Counts Foot Care Campaign.