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Diabetische Neuropathie und diabetischer Fuß (Update 2019)

Diabetic neuropathy and diabetic foot syndrome (Update 2019)

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Zusammenfassung

Der Begriff der diabetischen Neuropathie umfasst Mono- und Polyneuropathieformen, die diabetische Plexopathie, Radikulopathie und die autonome Neuropathie. Die Leitlinienempfehlungen beschreiben die klinischen Symptome und diagnostischen Möglichkeiten, sowie die Therapiemaßnahmen insbesondere bei der schmerzhaften Form der sensomotorischen Neuropathie, einschließlich der komplexen Problematik des diabetischen Fußes.

Summary

These are the guidelines for diagnosis and treatment of diabetic neuropathy and diabetic foot. Diabetic neuropathy comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy.

The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy, including the complex situation of the diabetic foot syndrome. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided. The needs to prevent and treat diabetic foot syndrome are summarized.

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Literatur

  1. American Diabetes Association. Microvascular complications and foot care. Standards of Medical Care in Diabetes 2018. Diabetes Care. 2018;41(Suppl 1):S105–S18.

    Article  Google Scholar 

  2. Ziegler D, Gries FA. Epidemiologie der peripheren diabetischen Neuropathie. Diabetes Stoffwechs. 1992;1:24–8.

    Google Scholar 

  3. Callaghan BC, Cheng HAT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatment. Lancet Neurol. 2012;11:521–34.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Young MJ, Boulton AJM, Mac IEO, et al. A multicenter study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital population. Diabetologia. 1993;36:150–4.

    Article  CAS  PubMed  Google Scholar 

  5. Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck A, KORA Study Group. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Survey S2 and S3. Pain Med. 2009;10:393–400.

    Article  PubMed  Google Scholar 

  6. Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boultin AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34:2220–4.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Guastella V, Mick G. Strategies for the diagnosis and treatment of neuropathic pain secondary to diabetic peripheral sensory polyneuropathy. Diabetes Metab. 2009;35:12–9.

    Article  CAS  PubMed  Google Scholar 

  9. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29:1518–22.

    Article  PubMed  Google Scholar 

  10. Dyck PJ, Karnes JL, O’Brien PC, et al. The Rochester diabetic neuropathy study: reassessment of tests and criteria for diagnosis and staged severity. Neurology. 1992;42:1164–70.

    Article  CAS  PubMed  Google Scholar 

  11. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy and nephropathy in a population-based cohort: the Rochester diabetic neuropathy study. Neurology. 1993;43:817–24.

    Article  CAS  PubMed  Google Scholar 

  12. Maser RE, Steenkiste AR, Dorman JS, et al. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh epidemiology of diabetes complication study. Diabetes. 1989;38:1456–61.

    Article  CAS  PubMed  Google Scholar 

  13. Van de Pollyranse LV, Valk GD, Renders CM, Heine RJ, Eijk JTM. Longitudinal assessment of the development of diabetic polyneuropathies and associated risk factors. Diabet Med. 2003;19:771–9.

    Google Scholar 

  14. Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic neuropathy. Diabetes Metab Res Rev. 2012;28(Suppl 1):8–14.

    Article  PubMed  Google Scholar 

  15. Sima AA, Sugimoto K. Experimental diabetic neuropathy. An update. Diabetologia. 1999;42:773–88.

    Article  CAS  PubMed  Google Scholar 

  16. Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanism as therapeutic targets. Nat Rev Neurol. 2011;7:573–83.

    Article  CAS  PubMed  Google Scholar 

  17. Yagihashi S, Yamagishi SI, Wada RI, et al. Neuropathy in diabetic mice overexpressing human aldose reductase and effects of aldose reductase inhibitor. Brain. 2001;124:2448–58.

    Article  CAS  PubMed  Google Scholar 

  18. Hoeldike RD, Bryner KD, Van Dyke K. Oxidative stress and autonomic nerve function in early type 1 diabetes. Clin Auton Res. 2011;21:19–28.

    Article  Google Scholar 

  19. Doupis J, Lyons TE, Wu S, Gnardellis C, Dinh T, Veves A. Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy. J Clin Endocrinol Metab. 2009;94:2157–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Ziegler D. Diagnosis and treatment of diabetic autonomic neuropathy. Curr Diab Rep. 2011;3:216–27.

    Google Scholar 

  21. Vinik AI, Maser RE, Mitchell BD, Freema R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–79.

    Article  PubMed  Google Scholar 

  22. Tesfaye S, Vileikyte L, Rayman G, et al. On behalf of the toronto expert panel on diabetic neuropathy. Diabetes Metab Res Rev. 2011;27:629–38.

    Article  CAS  PubMed  Google Scholar 

  23. Mueller MJ. Identifying patients with diabetes mellitus who are at risk for lower-extremity complications: use of Semmes-Weinstein monofilaments. Phys Ther. 1996;76:68–71.

    Article  CAS  PubMed  Google Scholar 

  24. Meijer JW, Bosma E, Leprandt JD, Links TP, Smit AJ, Stewart RE, Van Der Hoeven JH, Hoogenberg K. Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptoms and diabetic neuropathy examination score. Diabetes Care. 2003;26:697–701.

    Article  PubMed  Google Scholar 

  25. Rahman M, Griffin SJ, Rathman W, Wareham NJ. How should peripheral neuropathy be assessed in people with diabetes in primary care? A population-bases comparison of four measures. Diabet Med. 2003;20:368–74.

    Article  CAS  PubMed  Google Scholar 

  26. Zochodne DW. Diabetes mellitus and the peripheral nervous system: Manifestations and mechanisms. Muscle Nerve. 2007;36:144–66.

    Article  CAS  PubMed  Google Scholar 

  27. Feldman EL. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17:1281–9.

    Article  CAS  PubMed  Google Scholar 

  28. Bril V, England JD, Franklin GM, Backonja M, Cohen JA, Del Toro DR, Feldman EL, Iverson DJ, Perkins B, Russell JW, Zochodne DW. Evidence-based guideline: treatment of painful diabetic neuropathy—report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine& Rehabilitation. Muscle Nerve. 2011;43:910–7.

    Article  PubMed  Google Scholar 

  29. Bolton CF, Remtulla H, Toth B, Bernardi L, Lindsay RM, Maryniak O, Burton SR. Distinctive electrophysiological features of denervated muscle in uremic patients. J Clin Neurophysiol. 1997;14:539–42.

    Article  CAS  PubMed  Google Scholar 

  30. Lauria G, Hsieh ST, Johansson O, Kennedy WR, Leger JM, Mellgren SI, Nolano M, Merkies ISJ, Polydefkis M, Smith AG, Sommer C, Valls-Solé J. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol. 2010;17:903–912, e44-9.

    Article  CAS  PubMed  Google Scholar 

  31. Malik RA, Kallinikos P, Abbott CA, van Schie CH, Morgan P, Efron N, Boulton AJ. Corneal confocal microscopy: a non-invasive surrogate of nerve fibre damage and repair in diabetic patients. Diabetologia. 2003;46:683–8.

    Article  CAS  PubMed  Google Scholar 

  32. Diabetes Control and Complication Trial Research Group.. The effects of intensive treatment of diabetes on the development and progressive of long term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  33. Martin CL, Albers J, Herman WH, et al. Neuropathy among the diabetes control and complications trial cohort 8 years after trial. Diabetes Care. 2006;29:340–4.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Gremizzi C, Vergani A, Paloschi V, Secchi A. Impact of pancreas transplantation on type 1 diabetes-related complications. Curr Opin Organ Transplant. 2010;15:119–23.

    Article  PubMed  Google Scholar 

  35. UK Prospective Diabetes (UKPDS) Group. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and rate of complication in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;12:837–63.

    Google Scholar 

  36. Holman RR, Paul SK, Bethal MA, et al. 10-years follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–84.

    Article  CAS  PubMed  Google Scholar 

  37. Amthor KF, Dahl-Jorgensen K, Berg TJ, et al. The effect of 8 years of strict glycaemic control on peripheral nerve function in IDDM patients. The Oslo study. Diabetologia. 1994;37:579–84.

    Article  CAS  PubMed  Google Scholar 

  38. Reichard P, Pihl M, Rosenqvist U, Sule J. Complications in IDDM are caused by elevated blood glucose levels:the Stockholm Diabetes Intervention Study (SDIS) at 10-years follow up. Diabetologia. 1996;31:1483–8.

    Article  Google Scholar 

  39. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcome in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.

    Article  Google Scholar 

  40. Duckworth W, Abraira C, Moritz T, et al. Intensive glucose control and complications in American Veterans with type 2 diabetes. N Engl J Med. 2009;8:129–39.

    Article  Google Scholar 

  41. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care. 2008;31(Suppl 2):255–61.

    Google Scholar 

  42. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with alpha-lipoic acid over 4 years in diabetic polyneuropathy: the Nathan 1 trial. Diabetes Care. 2011;34:2054–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. McIlduff CE, Rutkove SB. Critical appraisal of the use of alpha lipoic acid (thioctic acid) in the treatment of symptomatic diabetic polyneuropathy. Ther Clin Risk Manag. 2011;7:377–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  44. Agathos E, Tentolouris A, Eleftheriadou I, KAtsaouni P, Nemtzas I, Petrou A, Papanikolaou C, Tentolouris N. Effect of alpha-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res. 2018;46:1779–90.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J Diabetes Complicat. 2015;29:146–56.

    Article  PubMed  Google Scholar 

  46. Snedcor SJ, Sudharshan L, Cappelleri JC, Sadosky A, Mehta S, Botteman M. Systematic review and meta-analysis of pharmacological therapies for painful diabetic peripheral neuropathy. Pain Pract. 2014;14:167–84.

    Article  Google Scholar 

  47. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009; https://doi.org/10.1002/14651858.CD007076.pub2.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. J Am Med Assoc. 2005;293:217–28.

    Article  CAS  Google Scholar 

  49. Jeffcoate WJ, Vileikyte L, Boyko EJ, Armstrong DG, Boulton AJM. Current challenges and opportunities in the prevention and management of diabetic foot ulcers. Diabetes Care. 2018;41:645–52.

    Article  PubMed  Google Scholar 

  50. Ramsey SD, Newton K, Blough D, et al. Incidence, outcomes, and cost of foot ulcers in patients with diabetes. Diabetes Care. 1999;22:382–7.

    Article  CAS  PubMed  Google Scholar 

  51. Jude EB, Oyibo S, Chalmers N, Boulton AJM. Peripheral arterial disease in diabetic and nondiabetic patients. Diabetes Care. 2001;24:1433–7.

    Article  CAS  PubMed  Google Scholar 

  52. Bakker K, Apelqvist J, Schaper NC. Practical guidelines on the management and prevention of the diabetic foot 2011. Diabetes Metab Res Rev. 2012;28(Suppl 1):225–31.

    Article  PubMed  Google Scholar 

  53. International Working Group on the Diabetic Foot. 2015. http://www.iwgdf.org/files/2015/website_summary.pdf. Zugegriffen: 9. Juli 2015.

  54. American Diabetes Association, American Association of Clinical Endocrinologists, Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31:1679–85.

    Article  Google Scholar 

  55. European Stroke Organization, Aboyans V, Ricco JB, Bartelink ML, Björck M, Brodmann M, Cohnert T, Collet JP, Czerny M. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Soceity for Vascular Surgery (ESVS). Eur Heart J. 2018;39:762–821.

    Google Scholar 

  56. Schaper NC, Andros G, Apelqvist J, Bakker K, Lammer J, Lepantalo M, Mills JL, Reekers J, Shearman CP, Zierler RE, Hinchliffe RJ, et al. Specific guidelines for the diagnosis and treatment of peripheral arterial disease in a patients with diabetes and ulceration of the foot 2011. Diabetes Metab Res Rev. 2012;28(Suppl 1):236–7.

    Article  PubMed  Google Scholar 

  57. Brandl R, Stiegler H. Das diabetische Fußsyndrom – Pathogenese, Diagnostik, Therapie und Prävention. Dtsch Med Wochenschr. 2015;140:593–602.

    Article  PubMed  Google Scholar 

  58. Morbach S, Müller E, Reike H, Risse A, Rümenapf G, Spraul M. Diabetic foot syndrome. Exp Clin Endocrinol Diabetes. 2014;122:416–24.

    Article  CAS  PubMed  Google Scholar 

  59. Malecki R, Rosinski K, Adamiec R. Etiological factors of infections in diabetic foot syndrome—attempt to define optimal empirical therapy. Adv Clin Exp Med. 2014;23:39–48.

    Article  PubMed  Google Scholar 

  60. Game FL, Hinchliffe RJ, Apelqvist J, Armstrong DG, Bakker K, Hartemann A, Löndahl M, Price PE, Jeffcoate WJ. A Systematic review of interventions to enhance the healing of chronic ulcers of the foot in diabetes. Diabetes Metab Res Rev. 2012;28(Suppl 1):119–41.

    Article  PubMed  Google Scholar 

  61. Sanders LJ, Frykberg RG. Charcot neuroarthropathy of the foot. In: Bowker JH, Pfeifer MA, Hrsg. Levin and O’Neals’s. The diabetic foot. 6. Aufl. St. Louis: CV Mosby; 2001. S. 439–66.

    Google Scholar 

  62. Short DJ, Zgonis T. Management of osteomyelitis and bone loss in the diabetic charcot foot and ankle. Clin Podiatr Med Surg. 2017;34:381–7.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Interne Abteilung, Landeskrankenhaus Hochzirl–Natters, Hochzirl, 6170, Zirl, Österreich

    Monika Lechleitner

  2. Internistisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich

    Heidemarie Abrahamian

  3. Sonderkrankenanstalt Rehabilitationszentrum Alland, Alland, Österreich

    Claudia Francesconi

  4. Abteilung für Neurologie, Landeskrankenhaus Hochzirl–Natters, Zirl, Österreich

    Markus Kofler

  5. Universitätsklinik für Innere Medizin, Medizinische Universität Innsbruck, Innsbruck, Österreich

    Wolfgang Sturm

  6. Universitätsklinik für Innere Medizin, Medizinische Universität Graz, Graz, Österreich

    Gerd Köhler

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  1. Monika Lechleitner
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  2. Heidemarie Abrahamian
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  3. Claudia Francesconi
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  4. Markus Kofler
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  5. Wolfgang Sturm
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Correspondence to Monika Lechleitner.

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Interessenkonflikt

M. Lechleitner hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Honorare für Vorträge und Advisory Boards erhalten: Boehringer Ingelheim, Novo Nordisk, Sanofi. H. Abrahamian hat Vortragshonorare und Honorare für Beratungstätigkeit von folgenden Firmen erhalten: Eli Lilly, AstraZeneca, Boehringer Ingelheim, Amgen, Sanofi, Novo Nordisk, Servier, MSD. C. Francesconi hat Vortragshonorare und Honorar für Beratungstätigkeit von folgenden Firmen erhalten: Boehringer Ingelheim, AstraZeneca, Novo Nordisk, Lilly, Sanofi, MSD, Takeda, DEx Com. M. Kofler, W. Sturm und G. Köhler geben an, dass kein Interessenkonflikt besteht.

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Lechleitner, M., Abrahamian, H., Francesconi, C. et al. Diabetische Neuropathie und diabetischer Fuß (Update 2019). Wien Klin Wochenschr 131 (Suppl 1), 141–150 (2019). https://doi.org/10.1007/s00508-019-1487-4

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