Resolution of the Expert Council on the Rational Management of Patients with Diabetic Sensorimotor Polyneuropathy and Neuropathic Pain

Diabetic distal symmetric sensorimotor polyneuropathy (DPN) represents one of the most prevalent and clinically significant complications associated with diabetes mellitus (DM). The painful variant of this condition substantially diminishes the quality of life for affected individuals, is associated with sleep disorders, anxiety, and depression, and encompasses an increased risk of adverse outcomes. In real-world practice, reliance solely on screening questionnaires without neurological examinations can lead to the underdiagnosis of DPN, especially in its painless form, and the overdiagnosis of neuropathic pain. Objective. To articulate a consensus expert position regarding the rational diagnosis, routing, and treatment of patients with distal polyneuropathy and neuropathic pain across various levels of medical care. Materials and methods. The expert council conducted a thorough analysis of contemporary clinical guidelines, international consensus documents, the scientific literature, and the practical challenges associated with managing patients with diabetic polyneuropathy in both primary and specialized medical care settings. Results. The council identified key levels of patient referral, including primary health care, consultation with a neurologist and/or endocrinologist, and access to specialized pain management centers. A practice-oriented diagnostic algorithm for primary care is proposed that encompasses a targeted collection of patient complaints, assessment of symptomatology, evaluation of tactile, vibration, and pain sensitivity, and assessment of tendon reflexes. Clear indications for specialist referral, criteria for initiating therapy, treatment objectives for the painful variant of DPN, and strategies for assessing treatment effectiveness have been established. The successful implementation of these recommended approaches requires the development of a regulatory framework for patient routing, the introduction of concise clinical algorithms, the initiation of educational programs for primary care physicians, and the assurance of the availability of pharmacological therapy. Conclusions. Enhancing the quality of care for patients with distal polyneuropathy can be achieved through a strategic combination of organizational, educational, clinical, and methodological initiatives that facilitate early diagnosis and appropriate treatment.