Diabetic peripheral neuropathy: Person-centered care

ABSTRACT

Patients with diabetes mellitus may experience painful and nonpainful diabetic peripheral neuropathy (DPN). This article offers an overview of DPN and the clinical assessment and management of patients with DPN, as well as the nurse's role in supporting these patients.

Diabetic autonomic neuropathy resulting in sexual dysfunction

Although diabetic autonomic neuropathy (DAN), a complication associated with diabetes, is increasing in prevalence, it is often overlooked. Knowledge regarding the development and progression of this complication is limited. NPs are in a key position to prevent complications of DAN, including sexual dysfunction, in this vulnerable population.

A Nurse's Guide to the Prevention of Neuropathic Ulcers in Patients with Diabetes

Neuropathic ulcers present a significant issue for patients with diabetes. Neuropathic ulcers reduce mobility and increase the risk for infection and other complications. Prevention of ulceration is a primary nursing goal in the care of patients with diabetes.

[Guided clinical practice guidelines: how to blunt the weapon of evidence]

The public should trust practice guidelines only if the recommendations accurately reflect the underlying evidence about benefits and harms to individual patients. However, the process of development of clinical practice guidelines is fraught with problem, conflicts and controversies. A few examples, starting from the guidelines on osteoporosis are presented and commented on.

Isolated Use of Vibration Perception Thresholds and Semmes-Weinstein Monofilament in Diagnosing Diabetic Polyneuropathy: “The North Catalonia Diabetes Study”

Several systems are used for the diagnosis of diabeticpolyneuropathy (DPN). We analyzed the isolated use of vibration perception thresholds (VPTs) or monofilament (MF) for the diagnosis of DPN. A group of 400 patients who had type 2 diabetes was selected from the North Catalonia Study Group. A clinical neurologic evaluation was performed based on three categories of the San Antonio Consensus. Neurothesiometer and quantitative tuning fork explored VPT, and MF was assessed by Olmos and Michigan Diabetic Neuropathy Score (MDNS) criteria. The use of VPT and MF showed a high specificity and low sensitivity. MF, by MDNS criteria, was more sensitive and specific, and showed more accurate positive and negative predictive values. The predicted probability of DPN diagnosis was higher with a tuning fork evaluation.

Diabetes and peripheral neuropathy: keeping people on their own two feet

Peripheral neuropathy is one of the most common forms of diabetes-related neuropathy, and most commonly affects the feet. Loss of sensation leaves the feet at risk of damage--from environmental hazards, incorrectly fitting footwear or un-felt pressure damage--which can lead to the need for amputations. This article discusses how to reduce the risk of peripheral neuropathy through glycaemic control, and the steps that need to be taken to reduce the risk of injury on the neuropathic foot.

Identifying and managing the complications of diabetes

Diabetic complications are common, costly and have a major impact on length and quality of life. There is good evidence that they can be delayed or even prevented in type 1 and type 2 diabetes by achievement of normoglycaemia, control of other risk factors, regular review and early treatment. This article discusses the type of damage that can occur in both type 1 and type 2 diabetes, which patients are particularly vulnerable and why, the costs of diabetic complications, how they can be prevented, the nursing implications of caring for patients who already have damage and helping to prevent it in others.

Diabetes and its effect on wound healing and patient care

Diabetes is a multisystem disorder that affects the wound healing process. Physiological changes in tissues and cells may delay healing and complications of diabetes also have an impact. Given these factors, it is important for health care teams working across the acute community interface to manage diabetic wounds effectively.

Peripheral neuropathy in persons with diabetes

Diabetic peripheral neuropathy (DPN) is a common complication of both type I and II diabetes mellitus. Although the exact cause remains unknown, peripheral neuropathy can cause significant health concerns and decrease the quality of life for those with this condition. Diagnosis of DPN can be made when signs and/or symptoms of peripheral nerve dysfunction are present. Patients with diabetes should be evaluated yearly for DPN with a thorough history and physical examination emphasizing the feet. Strict glycemic control and daily foot care are of utmost importance in the management and prevention of DPN. Pharmacologic therapies for pain control include tricylic antidepressants, anticonvulsants, analgesics, and capsaicin. DPN remains a frequent and serious complication of diabetes mellitus, and left unmanaged, may lead to debilitating consequences of foot ulcers and amputations.

Foot ulceration in diabetic patients

Foot care is very important if patients with diabetes are to avoid ulceration complications. Kate Springett explains the importance of educating the patient to be aware of signs and symptoms of foot ulceration, and outlines the best management techniques within the scope of a multiprofessional care team.

Diabetic peripheral neuropathies

Diabetic peripheral neuropathy is not just a pain in the leg, a symptom of one of many diabetic peripheral neuropathies. Rather, diabetic peripheral neuropathy causes many symptoms, and requires individualized medical and nursing management based on the type of neuropathy.

Teaching foot care creatively and successfully

The purpose of this department is to pro vide a formal for sharing innovative educa tiotial strategies or tools for use in patient or professional diabetes education. Authors are invited to submit manuscripts that describe a strategy or tool and its im plications for practice. Manuscripts should be limited to three to five double-spaced pages and sent to Tool Chest edito r Kathryn Godley, MS, RN, CDE, 23 Harri son Avenue, Delmar; NY 12054.

Postoperative recovery: how diabetes complicates care

Diabetic patients comprise a significant portion of the overall number of coronary artery bypass graft surgery patients. These patients are at greater risk to develop complications postoperatively because of associated changes in their cardiovascular system. Diabetic patients may respond differently to cardiac surgery if they have autonomic neuropathy, microvascular changes, and macrovascular disease. Nurses must be aware of the effect of diabetes on the cardiovascular system and how this can affect patient recovery.

Chronic complications of diabetes mellitus

This article addresses the long-term or chronic complications of diabetes mellitus, including macroangiopathy, microangiopathy, and neuropathy, with a special emphasis on the insensate foot frequently seen in patients with diabetes. This article presents nursing strategies for assessment and suggestions for effective nursing interventions related to these complications. It also identifies some strategies for preventing further complications.

[Group educational intervention in diabetic foot: the objectives, pedagogical strategies, level of knowledge and results]

Detailed contents and aims of an educational intervention for diabetic foot are presented, together with evaluation tools and results at 3, 6 and 12 month interval after the course. Knowledge level and "health" of the foot were assessed at 12 month interval on 2/3 of the 100 diabetic patients originally exposed to the educational intervention. After 12 months 80% of patients showed a good retention of knowledge on practical issues related to foot care, while 77% of patients with persistent foot problems were not independent (because of hypo-mobility or sight problems) in foot care.

Nursing management of diabetic peripheral neuropathies

This article provides a brief description of each of the diabetic peripheral neuropathies. Each distinct peripheral neuropathy is discussed in terms of its incidence, symptomatology, physical signs, medical management, and prognosis. Then Leavell and Clark's Levels of Prevention is used as a framework for nursing intervention for the patient with diabetic peripheral neuropathies. Nursing intervention includes health promotion and specific protection, early diagnosis and prompt treatment, and rehabilitation.

Neurologic complications in diabetes mellitus

This article has discussed diabetic neuropathies and current knowledge about these somewhat baffling disorders. As research continues, new therapies for diabetic neuropathies will be found. Meanwhile, the nurse should remember that encouraging tight blood glucose control may be the best preventive therapy we have currently.