Медицинский совет (Jan 2021)
Management of patients with painful diabetic neuropathy: clinical case report
Abstract
Diabetic polyneuropathy is the most common neurological complication of diabetes mellitus (DM) and may affect about half of all patients with diabetes. Timely diagnosis and treatment of DPN can prevent such serious complications as limb numbness, severe pain during the day and night, foot ulceration and suppuration, amputation of the foot or toes, disability and even death. The combined approach to the treatment of DPN is the most effective and includes glycemic control, diet, optimal hypoglycemic therapy, management of cardiovascular diseases, educational conversations with patients, psychological support in the form of consultations with a psychologist or psychotherapy, and sufficient pathogenetic and symptomatic drug therapy of DPN. A clinical case of managing a patient with T2DM, DPN and cardiovascular diseases is described in detail. The interdisciplinary approach was used to treat the patient, which included the use of drug and non-drug therapies. The drug therapy of diabetes was adjusted, and medications to treat cardiovascular diseases were prescribed. Pathogenetic therapy of DPN remains a highly controversial issue. Among the drugs that affect the pathogenetic mechanisms of DPN, careful consideration was given to B vitamins and alpha lipoic acid. In the presented clinical case report, the patient was prescribed a combination drug containing vitamins B1, B6 and B12 as a pathogenetic therapy of DPN. A high priority in the treatment of DM and DPN is placed on raising awareness among patients about the causes and prognosis of the disease. Most patients with diabetes and DPN have psychological problems, symptoms of anxiety and depression about the disease, catastrophization of existing symptoms, poor adherence to medication due to feelings of despair and thoughts of the disease as incurable. In view of above factors, psychological methods appear as effective in the treatment of patients with diabetes and DPN. The cognitive behavioural therapy was used in the described clinical case as a psychological method. The use of CBT improved the patient’s emotional state, increased his adherence to medications and lifestyle recommendations. A positive effect in the form of decreased severity of neuropathic and autonomic symptoms of DPN was observed in as little as 10 days after treatment. At follow-up Week 12, the patient’s condition continued to improve and his work capacity increased.
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