Diagnosis and Management of Diabetic Polyneuropathy: an Updated Algorithmic Approach. A Review

INTRODUCTION. Diabetic polyneuropathy is one of the most frequent and disabling complications of diabetes mellitus, exerting a profound impact on both life expectancy and quality of life. In the context of the rapidly increasing prevalence of diabetes worldwide and in Russia, the timely diagnosis and effective management of diabetic polyneuropathy have become an urgent clinical priority. AIM. To consider summarizes current concepts of pathogenesis, classification, diagnostic algorithms, and therapeutic strategies for diabetic polyneuropathy, emphasizing an interdisciplinary perspective. MAIN CONTENT OF THE REVIEW. Particular attention is given to the importance of early detection, which can be achieved through validated clinical scales such as the Neuropathy Symptom Score (NSS) and Total Symptom Score (TSS), as well as simple screening tools such as the Ipswich Touch Test. The integration of these instruments into routine practice contributes to the standardization of diagnostics and enables the objective assessment of symptom dynamics during treatment. The therapeutic section focuses on pathogenetically based approaches, with α-lipoic acid, B vitamins, and ipidacrine (Neiromidin®) playing a central role. Ipidacrine, in particular, has demonstrated efficacy in improving neuromuscular transmission, enhancing sensory function, and reducing pain severity, as supported by several clinical studies. CONCLUSION. The implementation of algorithm-based diagnostic and therapeutic approaches, the early use of pathogenetically targeted agents, and the development of personalized management strategies open new prospects for reducing the risk of severe complications and improving the quality of life in patients with diabetic polyneuropathy.