Diagnostic Approach to Peripheral Neuropathy

Clinical Assessment and Diagnostic Testing

The American Diabetes Association recommends that patients with type 2 diabetes and symptoms of peripheral neuropathy, such as burning pedal edema with tingling and pain, should undergo electromyography and nerve conduction studies to determine the etiology and severity of their neuropathy, especially in the presence of diminished vibration and pinprick sensation in distal lower extremities 1, 2
Patients with long-standing type 2 diabetes and poor glycemic control, indicated by an HbA1c level of 8.1%, are at increased risk of developing peripheral neuropathy, and their condition should be managed accordingly 1
The American College of Cardiology notes that a 20-year history of cigarette smoking is a significant risk factor for peripheral neuropathy and vascular disease, emphasizing the need for smoking cessation 3

The American Diabetes Association suggests that optimizing glycemic control, with a target HbA1c <7%, is crucial in preventing the progression of diabetic neuropathy 2
For patients with painful diabetic neuropathy, the FDA-approved medications pregabalin, duloxetine, or tapentadol may be considered for pain management, based on the severity and pattern of neuropathy 6
Comprehensive foot care education is essential for patients with loss of protective sensation, to prevent further complications, and annual comprehensive foot examinations are recommended for high-risk patients 1, 8, 9

Smoking cessation is critical, as smoking contributes to both neuropathy and vascular disease, according to the American College of Cardiology 3