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

Table 4

Recommendations for autonomic dysfunction management.

Symptom

Management

ADA

UMHS

PNICE

IDF

AACE

NZGG

AAN

TEPDN

SFD

SIGN

EFNS

NICE

SADA

Cardiac system

Exercise intolerance

—

—

—

—

●

—

—

●

—

—

—

—

●

Orthostatic hypotension

●

—

—

—

●

—

—

●

—

—

—

—

●

Gastrointestinal system

Gastroparesis

Metoclopramide

●

—

—

●

●

—

—

—

—

—

—

●

●

Domperidone

—

—

—

●

●

—

—

—

—

—

—

●

●

Erythromycin

●

—

—

—

●

—

—

—

—

—

—

●

●

Constipation

—

—

—

—

●

—

—

—

—

—

—

—

●

Diarrhea

—

—

—

—

●

—

—

—

—

—

—

●

●

Abdominal discomfort

—

—

—

—

●

—

—

—

—

—

—

—

●

Urogenital system

Erectile dysfunction

PDE5 inhibitor

●

—

—

●

●

—

—

—

—

—

—

●

●

Prostaglandins

●

—

—

—

●

—

—

—

—

—

—

—

●

Vacuum device

●

—

—

—

●

—

—

—

—

—

—

—

●

Surgery

●

—

—

—

●

—

—

—

—

—

—

●

●

Psychological counseling

—

—

—

●

●

—

—

—

—

—

—

●

●

Vaginal dryness

Lubricant

—

—

—

—

●

—

—

—

—

—

—

—

●

Bladder dysfunction

—

—

—

—

●

—

—

—

—

—

—

—

●

Sudomotor dysfunction

—

—

—

—

●

—

—

—

—

—

—

●

●

Pupillomotor and visceral dysfunction

—

—

—

—

●

—

—

—

—

—

—

—

●

● indicates recommended; — indicates not mentioned.
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.