Section 12: Retinopathy, Neuropathy, and Foot Care

Recommended DR screenings can allow for timely treatment to prevent or reverse vision loss.

All people with diabetes should be assessed for diabetic peripheral neuropathy (DPN):

• Starting at the diagnosis of type 2 diabetes

• 5 years after the diagnosis of type 1 diabetes

• At least annually thereafter

Symptoms and signs of autonomic neuropathy should be assessed:

• Starting at the diagnosis of type 2 diabetes

• 5 years after the diagnosis of type 1 diabetes

• At least annually thereafter

• With evidence of other microvascular complications, particularly kidney disease and DPN

• Various drugs may reduce pain from DPN, and both drug and non-drug strategies may ease symptoms of DPN and autonomic neuropathy.

• The safest and most evidence-based pharmacologic options for DPN include gabapentinoids, serotonin- norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers.

• Refer to a neurologist or pain specialist when pain control is not achieved within the scope of practice of the treating clinician.

Initial treatment recommendations should include:

• Daily foot inspection

• Use of moisturizers for dry, scaly skin and avoidance of self-care of ingrown nails and calluses

• Well-fitted athletic or walking shoes with customized pressure-relieving orthoses for people with increased plantar pressures (e.g., with plantar calluses).