Opioids are not recommended as first- or second-line agents for treating diabetic distal symmetric polyneuropathy (DSPN) because of the high risks of addiction and other complications, according to a new position statement from the American Diabetes Association on diabetic neuropathy.
The document was developed by a group of internationally-recognised endocrinologists and neurologists from both sides of the Atlantic.
It recommends that either pregabalin or duloxetine should be considered as the initial approach to managing patients with DSPN. Gabapentin can also be considered as an effective initial approach, it states, but the patient’s socioeconomic status, comorbidities and potential drug interactions must be taken into consideration. Tricyclic antidepressants are also effective, it says, but should be used with caution because of the higher risk of serious side effects.
The new position statement also provides recommendations on the overall prevention of diabetic neuropathy and provides guidance on managing and treating other diabetic neuropathies, and includes an algorithm that can be used in the clinical care setting to help decide if a patient needs to be referred to a neurologist.