Distal symmetric polyneuropathy (DSPN), the\nmost common form of diabetic neuropathy, has a complex\npathophysiology and can be a major source of physical and\npsychologic disability. Themanagement ofDSPN can be frustrating\nfor both patient and physician. This article provides a\ngeneral overview of typical patient pathways in DSPN, and\nhighlights variations in diagnosis, management, and referral\npatterns among different providers. DSPN is managed in several\nsettings by primary care physicians (PCPs), specialists,\nand nurse practitioners. The initial clinical management of\nthe patient is often dependent on the presenting complaint,\nthe referral pattern of the provider, level of comfort of the\nPCP in managing diabetic complications, and geographic access\nto specialists. The primary treatment of DSPN focuses\nmainly on glycemic control and adjustment of modifiable risk\nfactors, but other causes of neuropathy should also be investigated.\nSeveral pharmacologic agents are recommended by\ntreatment guidelines, and as DSPN typically exists with comorbid\nconditions, a multimodal therapeutic approach should\nbe considered. Barriers to effective management include failure\nto recognize DSPN, and misdiagnosis. Patient education\nalso remains important. Referral patterns vary widely according\nto geographic location, access to services, provider preferences,\nand comfort in managing complex aspects of the\ndisease. The variability in patient pathways affects patient\neducation, satisfaction, and outcomes. Standardized screening\ntools, a multidisciplinary team approach, and treatment algorithms\nfor diabetic neuropathy should improve future care. To\nimprove patient outcomes, DSPN needs to be diagnosed sooner\nand interventions made before significant nerve damage\noccurs.
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