People with DN are particularly at risk of painless foot injuries. Preventing foot ulceration is important, as subsequent wound infection and gangrene can lead to amputation. All patients should be screened for DN at diagnosis of type 2 diabetes or impaired glucose tolerance, and 5 years after diagnosis of type 1 diabetes.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Screening should be conducted at least annually thereafter, using simple clinical tests.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Proper care of the foot and prevention of ulceration begins with educating the patient on proper foot care.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Referral for specialised footwear may be indicated to relieve pressure points and reduce risk of foot trauma.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
The use of specialised therapeutic footwear is recommended for high-risk patients with diabetes, such as those with loss of protective sensation (i.e., severe neuropathy), foot deformities, ulcers, callus formation, poor peripheral circulation, or a history of amputation.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Patients also need to check their feet daily and report any injuries or wounds at an early stage.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
One review of 13 randomised clinical trials assessed the benefits and efficacy of various interventions on the prevention of future diabetic foot ulcers. It found that only foot temperature-guided avoidance therapy was beneficial.[270]Arad Y, Fonseca V, Peters A, et al. Beyond the monofilament for the insensate diabetic foot: a systematic review of randomized trials to prevent the occurrence of plantar foot ulcers in patients with diabetes. Diabetes Care. 2011 Apr;34(4):1041-6.
https://diabetesjournals.org/care/article/34/4/1041/38825/Beyond-the-Monofilament-for-the-Insensate-Diabetic
http://www.ncbi.nlm.nih.gov/pubmed/21447666?tool=bestpractice.com
Cardiovascular autonomic testing is recommended before a patient with diabetes begins a moderate- or high-intensity exercise programme. People with known cardiovascular autonomic dysfunction should be advised about the need for appropriate hydration when exercising.
Optimal glucose, blood pressure and serum lipid control is recommended to both reduce the risk of and slow the progression of DN in people with type 1 and type 2 diabetes.[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Control of modifiable risk factors (glucose, obesity, blood pressure, and lipids) in addition to adhering to a healthy lifestyle may prevent other associated microvascular complications of diabetes (retinopathy and nephropathy).[39]American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.
https://diabetesjournals.org/care/article/48/Supplement_1/S1/157562/Introduction-and-Methodology-Standards-of-Care-in
http://www.ncbi.nlm.nih.gov/pubmed/39651982?tool=bestpractice.com
Patients with painful DN should be assessed for presence of comorbid mood and sleep disorders (e.g., major depressive disorder, obstructive sleep apnoea).[66]Price R, Smith D, Franklin G, et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary. Report of the AAN Guideline Subcommittee. Neurology. 2022 Jan 4;98(1):31-43.
https://n.neurology.org/content/98/1/31
http://www.ncbi.nlm.nih.gov/pubmed/34965987?tool=bestpractice.com