A Malaysian Expert Consensus on The Identification, Evaluation, and Pharmacological Management of Diabetic Sensorimotor Polyneuropathy

Diabetic sensorimotor polyneuropathy (DSPN), the most common form of diabetic peripheral neuropathy (DPN), is a chronic complication of diabetes associated with sensory loss, foot ulceration, lower-limb amputation, reduced quality of life, and increased mortality. Despite its substantial clinical burden, DSPN remains underdiagnosed and undertreated in Malaysia. This consensus aimed to develop practical, evidence-informed recommendations for screening, diagnosis, and management of painful and non-painful presentations of DSPN tailored to the Malaysian healthcare setting. An expert panel comprising 11 endocrinologists from public and private healthcare institutions in Malaysia was convened. Draft recommendations were adapted from international and local guidelines for Malaysian clinical practice. Consensus development involved pre-meeting review and anonymous voting, followed by structured face-to-face discussion. Consensus was defined as ≥80% agreement. The panel finalized 61 consensus statements covering screening, diagnosis, sensory examination, and treatment. Recommendations emphasize annual screening for all individuals with diabetes and clinical examination to detect sensory deficits, including in individuals without painful symptoms. Assessment should include multiple bedside tests to evaluate small- and large-fiber function and loss of protective sensation. Recommended tests include the 10-g monofilament, vibration and pin-prick testing, and the Ipswich Touch Test, particularly in resource-limited settings. Assessment of painful and non-painful symptoms should complement rather than replace objective examination. Validated screening questionnaires, including the Malay-language PainDETECT may support assessment. Management includes optimization of glycemic control, lifestyle interventions, adjunctive pathogenetically oriented therapies such as alpha-lipoic acid, and evidence-based pharmacological treatments including pregabalin, gabapentin, duloxetine, and tricyclic antidepressants. Routine opioid use is discouraged. This Malaysian expert consensus provides practical, context-specific recommendations for early detection, diagnosis, and management of DSPN. By adapting international guidance to local healthcare realities, these recommendations aim to improve care consistency, reduce DSPN-related complications, and enhance patient outcomes in Malaysia. Diabetic sensorimotor polyneuropathy (DSPN) is the most common form of diabetic peripheral neuropathy and primarily affects the feet and legs. It can cause loss of sensation, numbness, tingling, imbalance, or burning and other painful sensations. Importantly, many people with DSPN have no pain or noticeable symptoms despite having sensory loss. If left undetected, DSPN can increase the risk of foot ulcers, infections, and lower-limb amputation. This article presents recommendations developed by a panel of Malaysian diabetes specialists to improve the screening, diagnosis, and management of DSPN. The recommendations were adapted from international and local guidance, and refined through expert discussion and voting. Regular screening is important because nerve damage may develop before symptoms become noticeable. Healthcare professionals should therefore not wait for pain or other symptoms before assessing for DSPN. Clinical examination of sensation in the feet is central to detection and should include simple bedside tests such as the 10-g monofilament and vibration testing, with pin-prick or temperature testing where appropriate. Questionnaires about painful and non-painful symptoms can complement clinical examination. Management includes good blood sugar control, regular physical activity, weight management, and healthy lifestyle measures. For painful DSPN, treatment options include medicines such as pregabalin, duloxetine, and tricyclic antidepressants. Alpha-lipoic acid may also be considered as an additional treatment option in selected patients. These recommendations provide practical guidance for healthcare professionals in Malaysia with the aim of supporting earlier detection, appropriate treatment, prevention of complications, and improved quality of life for people with DSPN.