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 The nursing management of a patient with peripheral artery disease (PAD) begins with a thorough assessment of the patient’s health history and clinical manifestations.AssessmentHealth History: Evaluate the patient’s history of hypertension, hyperlipidemia, family history of cardiovascular issues, and lifestyle factors such as dietary patterns, smoking, and physical activity.Physical Examination:Assess the affected extremity for decreased or absent peripheral pulses,...
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Clinical manifestationsPeripheral Arterial Disease (PAD) manifests through a range of symptoms, from the characteristic intermittent claudication to atypical presentations and severe complications in advanced stages. Intermittent claudication, a hallmark symptom of PAD, presents as exercise-induced muscle pain that typically resolves within minutes of rest. This pain is reproducible and stems from inadequate blood flow, leading to the accumulation of lactic acid produced during anaerobic...
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Peripheral artery disease (PAD) predominantly results from atherosclerosis, which involves the accumulation of fatty deposits, or plaques, within the walls of arteries. This causes them to narrow and harden, significantly reducing blood flow. PAD predominantly affects the legs but also impacts other areas, such as the arms, thereby impairing overall circulation and organ function.Etiology of PAD:The principal cause of PAD is atherosclerosis, which results from fatty deposits inside the arterial...
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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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For most patients, experiencing several weeks of polyuria, polydipsia, fatigue, and significant weight loss may indicate the presence of diabetes. Furthermore, adults displaying the phenotypic appearance of type 2 diabetes (particularly those who are obese and not initially insulin-requiring), may have islet cell autoantibodies, suggesting autoimmune-mediated β cell destruction and a diagnosis of latent autoimmune diabetes of adults (LADA). The categorization of glucose homeostasis is...
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Diabetic peripheral neuropathy essentials: a narrative review.

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  • 1Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, South Korea.

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Summary

Painful diabetic peripheral neuropathy (DPN) affects millions, causing quality of life reduction. This review details DPN pathophysiology, diagnosis, and treatment options for clinicians.

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Area of Science:

  • Neurology
  • Endocrinology

Background:

  • Diabetic peripheral neuropathy (DPN) impacts 6-34% of diabetic patients, significantly reducing quality of life.
  • Distal symmetric polyneuropathy (DSPN) is the most prevalent form of DPN, characterized by progressive nerve damage.
  • Key underlying factors include hyperglycemia in type 1 and dyslipidemia in type 2 diabetes.

Approach:

  • A comprehensive literature search of MEDLINE (PubMed) was performed for English-language articles up to April 1, 2022.
  • Search terms included various combinations of 'diabetes mellitus,' 'neuropathy,' 'polyneuropathy,' 'diabetic neuropathies,' 'peripheral neuropathy,' 'diabetic polyneuropathy,' 'pathophysiology,' 'diagnosis,' and 'treatment.'

Key Points:

  • DPN involves C and Aδ fiber damage, leading to distal-to-proximal axonal loss and characteristic 'glove and stocking' sensory symptoms.
  • Pain is described as burning, electric, sharp, or dull aching, with varying intensities.
  • Diagnosis is achieved through a process of exclusion, requiring thorough medical history, physical examination, and clinical testing.
  • Pharmacological treatments include anticonvulsants (pregabalin, gabapentin), antidepressants (duloxetine, venlafaxine, amitriptyline), opioids (tramadol, tapentadol, oxycodone), and topical capsaicin.
  • Combination therapy with 2-3 agents can improve pain resolution and reduce side effects.

Conclusions:

  • Accurate diagnosis and appropriate treatment of DPN are crucial for effective patient management.
  • This review equips clinicians with essential knowledge regarding DPN pathophysiology, diagnosis, and treatment strategies.