Diabetic Neuropathy and Foot Care: Standards of Medical Care in Diabetes-2019

Lyh Jyh Hao, Chwen Yi Yang, Eugene Hsin Yu, Hsiu Yun Hsu, Ying Tso Shen, Hong Teng Chen, Hung Pin Tan, Chin Wang Chen, Jue Long Wang, Meng Hua Huang

Research output: Contribution to journalArticlepeer-review


The diabetic neuropathies are a heterogeneous group of disorders with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is required. The most important treatment of diabetic neuropathy is optimal glucose control. Foot care is crucial to prevent ulceration, infection, and amputation. For patients with painful diabetic neuropathy, we suggest initial therapy using either amitriptyline or venlafaxine, duloxetine or pregabalin. If patients fail with single drug therapy, it is recommended that the composite treatment using two different classes of drugs. Alternative replacement therapy, including capsaicin cream, lidocaine patch, a-lipoic acid or transcutaneous electrical nerve stimulation. A new section was added in this standard medical care to describe the mixed evidence on the use of hyperbaric oxygen therapy in people with diabetic foot ulcers. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone. (J Intern Med Taiwan 2019; 30: 368-379).

Original languageEnglish
Pages (from-to)368-379
Number of pages12
JournalJournal of Internal Medicine of Taiwan
Issue number6
Publication statusPublished - 2019 Dec

All Science Journal Classification (ASJC) codes

  • Internal Medicine


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