Critical Appraisal of International Guidelines for the Management of Diabetic Neuropathy: Is There Global Agreement in the Internet Era?

Table 2

Recommendations for minimizing risk factors and complications and treatment-based pathogenetic mechanisms of diabetic neuropathy.

ADA

UMHS

PNICE

IDF

AACE

NZGG

AAN

TEPDN

SFD

SIGN

EFNS

NICE

SADA

Risk factors and complications

Glycemic factor

Stable and optimal glycemic control

●

●

—

●

●

●

—

●

○

●

—

●

●

Nonglycemic factor

Blood pressure control

—

—

—

—

●

—

—

—

—

—

—

—

●

Blood lipid level control

—

—

—

—

●

—

—

—

—

—

—

—

●

Lifestyle modification

—

●

—

—

●

—

—

●

—

●

—

●

●

Multifactorial intervention

●

—

—

●

—

●

●

—

●

—

—

—

Foot care

Foot self-care education

●

●

—

●

●

●

—

—

—

●

—

●

●

Regular comprehensive foot exam

●

●

—

●

●

●

—

—

—

●

—

●

●

Referral to multidisciplinary foot-care team

●

●

—

●

—

●

—

—

—

●

—

●

●

Psychological support^*

●

●

●

●

—

●

—

—

—

●

—

●

—

Pathogenetic mechanisms

Reducing oxidative stress

Alpha-lipoic acid

—

—

—

—

—

—

○

●

○

—

—

—

●

Improving metabolic disorder

Epalrestat

—

—

—

—

—

—

—

—

—

—

—

—

●

Fidarestat

—

—

—

—

—

—

—

—

—

—

—

—

●

Ranirestat

—

—

—

—

—

—

—

—

—

—

—

—

●

Improving microcirculation

ACE inhibitors

—

—

—

—

—

—

—

—

●

—

—

—

●

Prostaglandin analogs

—

—

—

—

—

—

—

—

—

—

—

—

●

● indicates being recommended; ○ indicates being not recommended; — indicates being not mentioned.
Psychological support^* indicates assessment of psychological stress or antidepression therapy.
ACE indicates angiotensin-converting enzyme. IDF indicates the International Diabetes Federation. NICE indicates the National Institute for Health and Clinical Excellence. SIGN indicates the Scottish Intercollegiate Guidelines Network. AACE indicates the American Association of Clinical Endocrinologists. NZGG indicates the New Zealand Guidelines Group. AAN indicates the American Academy of Neurology. TEPDN indicates the Toronto Expert Panel on Diabetic Neuropathy. SADA indicates Statement by the American Diabetes Association. PNICE indicates the guidelines for neuropathic pain from the National Institute for Health and Clinical Excellence. ADA indicates the American Diabetes Association. SFD indicates the Working Group on the Diabetic Foot from the French-Speaking Society of Diabetology. EFNS indicates the European Federation of Neurological Societies. UMHS indicates the University of Michigan Health System.