Atypical progression of neuropathy, relative lack of coexistent retinopathy or neuropathy, failure to achieve adequate control of dysaesthesia and secondary problems associated with diabetic neuropathy are all indicators for urgent patient review and possible referral.
- Neuropathy is often the ‘forgotten complication’ of diabetes.
- Dysaesthesia followed by anaesthesia, autonomic neuropathy and then motor neuropathy is the typical clinical course of peripheral diabetic neuropathy.
- Nondiabetic causes of neuropathy should always be considered when a patient with diabetes presents with neuropathic symptoms.
- The most important neuropathic red flags prompting review and consideration of referral in patients with diabetes are atypical anatomical patterns of neuropathy, atypical progress of neuropathy and relative lack of other associated microvascular complications.
- Other red flags include failure to achieve adequate control of dysaesthesia and secondary problems associated with diabetic neuropathy (especially anaesthetic feet) should also prompt review.