Neuropathy is one of the major complication in diabetes mellitus type 2. What can be done for a patient with this condition in a primary care setting besides management for blood glucose control? How effective can it be in affecting the prognosis of complication process?
Diabetic neuropathy is a microvascular complication experienced by most diabetic patients in primary care. Primary prevention of this complication has traditionally been a watertight control of HbA1c levels.
However, we do not know at the point of diagnosis if the patient has been diabetic all this while, which adds more years to being exposed to uncontrolled diabetes hence diabetic neuropathy.
Focus, therefore, should rest on detecting patients with impaired glucose tolerance (IGT). This would cut short the duration of being diabetics and might even prevent diabetes. This is an ideal form of primary prevention.
Secondary prevention is useful to patients who already have diabetes or diabetic neuropathy. A multidisciplinary approach is needed which involves a diabetic nurse, rehab personnel and the doctor. Patients will be taught on how to identify ulcers and prevent them if they have diabetic neuropathy. Grading of neuropathy will be done by the rehab personnel (which provides excellent information to the doctor and diabetic nurse/educator)
There are widely available medication that might help alleviate the pain of neuropathy. This can range from medications like amitryptyline, gabapentin to pregabalin. Alternatively, referrals to pain clinics might also help patients deal with this problem.
Rabin
There is some evidence from clinical trials for Gingko biloba as well as for Oenethera biennis (Evening primrose oil)