diaendoСахарный диабетDiabetes mellitus2072-03512072-0378Endocrinology research centre10.14341/DM9625diaendo-9625Research ArticleДоказательная диабетологияEvidence Based DiabetologyДиагностика и рациональная терапия болевой формы диабетической периферической нейропатии: междисциплинарный консенсус экспертовDiagnosis and rational treatment of painful diabetic peripheral neuropathy: an interdisciplinary expert consensushttps://orcid.org/0000-0001-6581-4521ГалстянГагик РадиковичGalstyanGagik R.

д.м.н., профессор

MD, PhD, Professor

galstyangagik964@gmail.comhttps://orcid.org/0000-0002-3328-2812СтаростинаЕлена ГеоргиевнаStarostinaElena G.

д.м.н., профессор

MD, PhD, Professor

elena.starostina59@yandex.ruhttps://orcid.org/0000-0002-8255-5645ЯхноНиколай НиколаевичYakhnoNikolay N.

д.м.н., профессор, академик РАН

MD, PhD, Professor

yahno@mma.ruГурьеваИрина ВладимировнаGurievaIrina V.

д.м.н., профессор

MD, PhD, Professor

igurieva@mail.ruhttps://orcid.org/0000-0001-6542-1963ЧурюкановМаксим ВалерьевичChuryukanovMaxim V.

к.м.н., доцент

MD, PhD, associate professor

mchurukanov@gmail.comhttps://orcid.org/0000-0001-6950-7166СтроковИгорь АлексеевичStrokovIgor A.

доцент, к.м.н.

MD, PhD, associate professor

strigoral@mail.ruhttps://orcid.org/0000-0003-2474-9924ТокмаковаАлла ЮрьевнаTokmakovaAlla Y.

д.м.н.

MD, PhD

alla-tokmakova@yandex.ruhttps://orcid.org/0000-0002-9406-5846КукушкинМихаил ЛьвовичKukushkinMikhail L.

д.м.н., профессор

MD, PhD, Professor

mkuk57@gmail.comhttps://orcid.org/0000-0002-9176-2128МартыновАнатолий ИвановичMartynovAnatoly I.

д.м.н., профессор, академик РАН

MD, PhD, Professor

anatmartynov@mail.ruhttps://orcid.org/0000-0002-5057-127XШестаковаМарина ВладимировнаShestakovaMarina V.

д.м.н., профессор, академик РАН

MD, PhD, Professor

nephro@endocrincentr.ruНациональный медицинский исследовательский центр эндокринологииРоссияEndocrinology Research CentreRussian FederationМосковский областной научно-исследовательский клинический институт им. М.Ф. ВладимирскогоРоссияMoscow Regional Research and Clinical InstituteRussian FederationПервый Московский государственный медицинский университет им. И.М. Сеченова (Сеченовский университет)РоссияI.M. Sechenov First Moscow State Medical UniversityRussian FederationРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian FederationМосковский Государственный медико-стоматологический университет им. А.И. ЕвдокимоваРоссияA.I. Evdokimov Moscow State Medical Stomatological UniversityRussian Federation201925102019224305327Copyright © Галстян Г.Р., Старостина Е.Г., Яхно Н.Н., Гурьева И.В., Чурюканов М.В., Строков И.А., Токмакова А.Ю., Кукушкин М.Л., Мартынов А.И., Шестакова М.В., 20192019Галстян Г.Р., Старостина Е.Г., Яхно Н.Н., Гурьева И.В., Чурюканов М.В., Строков И.А., Токмакова А.Ю., Кукушкин М.Л., Мартынов А.И., Шестакова М.В.Galstyan G.R., Starostina E.G., Yakhno N.N., Gurieva I.V., Churyukanov M.V., Strokov I.A., Tokmakova A.Y., Kukushkin M.L., Martynov A.I., Shestakova M.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.dia-endojournals.ru/jour/article/view/9625

Диабетическая периферическая нейропатия (ДПН) – распространенное хроническое осложнение сахарного диабета (СД), значительно нарушающее самочувствие, качество жизни и функционирование пациентов. Показатели распространенности ДПН в РФ колеблются от 0,1% до 67,2% при СД 1 типа и от 0,1 до 42,4% при СД 2 типа. Однако, судя по широкомасштабным эпидемиологическим исследованиям, истинная распространенность ДПН гораздо выше (50–70%), причем ее болевая форма встречается у 16–30% пациентов. Несмотря на то что периферическая нейропатия остается самым распространенным хроническим осложнением СД, ее диагностика и терапия оставляют желать лучшего. Для оптимизации подходов к диагностике и лечению болевой формы ДПН группой экспертов, представляющих ведущие российские профессиональные медицинские сообщества, были разработаны консенсусные клинические рекомендации по диагностике и рациональной терапии пациентов с болевой формой ДПН.

В данном документе представлены практические аспекты клинической диагностики болевой формы нейропатии и алгоритм дифференциальной диагностики болевого синдрома в нижних конечностях у больных СД. Руководствуясь основными аспектами патофизиологии нейропатической боли, обосновано применение симптоматических обезболивающих препаратов центрального действия – противосудорожных, антидепрессантов и опиоидов. Дана характеристика каждого класса препаратов, рассмотрены доказательные данные об эффективности, переносимости, а также возможности комбинированной терапии. Представлены данные о препаратах 1-й, 2-й и 3-й линии в соответствии с несколькими международными клиническими рекомендациями. Подчеркнута необходимость индивидуального подбора препарата с учетом доказательных данных по их эффективности и безопасности, сопутствующей медикаментозной терапии, переносимости, стоимости и предпочтений пациента, возраста больного и сопутствующих заболеваний.

Diabetic peripheral neuropathy is a common chronic complication of diabetes mellitus, significantly impairing well-being, quality of life and functioning of patients. The prevalence of diabetic peripheral neuropathy in the Russian Federation ranges from 0.1% to 67.2% in type 1 and from 0.1 to 42.4% in type 2 diabetes mellitus. However, based on the large-scale epidemiological studies, the true prevalence of diabetic peripheral neuropathy is much higher (50 to 70%), with its painful variant occurring in 16% to 30% of patients. Despite the fact that diabetic peripheral neuropathy remains the most common chronic complication of diabetes mellitus, its diagnosis and therapy leave much to be desired. To optimize diagnostic and treatment approaches to painful diabetic peripheral neuropathy, a group of experts representing the leading Russian professional medical associations has developed clinical guidelines for the diagnosis and rational therapy of patients with painful diabetic peripheral neuropathy.

This document presents practical aspects of the clinical diagnosis of painful diabetic peripheral neuropathy and an algorithm for differential diagnosis of pain in the lower extremities in patients with diabetes mellitus. The use of symptomatic analgesics with central action, such as anticonvulsants, antidepressants and opioids, is based on the main aspects of neuropathic pain pathophysiology. The characteristics of each drug class are given, with consideration of evidence on their efficacy, tolerability, and the possibility of combination therapy. The data on the first, second, and third lines of agents is presented in accordance with several international clinical guidelines. The need for a tailored drug choice, taking into account the evidence-based data on their efficacy and safety, concomitant drug therapy, tolerability, cost and preferences of the patient, age of the patient and concomitant disorders, is emphasized.

сахарный диабетдиабетическая периферическая нейропатияболевая нейропатиянейропатическая больдиагностикалечениеdiabetes mellitusdiabetic peripheral neuropathypainful neuropathyneuropathic paindiagnosistreatmentReferencesДедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета // Сахарный диабет. — 2017. — Т. 20. — №1. — С. 13-41. [Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes mellitus. 2017;20(1):13-41. (In Russ.)] doi: https://doi.org/10.14341/DM8664Дедов И.И., Шестакова М.В., Викулова О.К. Эпидемиология сахарного диабета в Российской Федерации: клинико-статистический анализ по данным Федерального регистра сахарного диабета // Сахарный диабет. — 2017. — Т. 20. — №1. — С. 13-41. [Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes mellitus. 2017;20(1):13-41. (In Russ.)] doi: https://doi.org/10.14341/DM8664Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. / Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. – 9-й выпуск // Сахарный диабет. — 2019. — Т. 22. — №1S. [Dedov II, Shestakova MV, Mayorov AY, et al. Standards of specialized diabetes care. 9th edition. Diabetes mellitus. 2019;22(1S). (In Russ.)] doi: https://doi.org/10.14341/DM221S1Дедов И.И., Шестакова М.В., Майоров А.Ю., и др. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. / Под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. – 9-й выпуск // Сахарный диабет. — 2019. — Т. 22. — №1S. [Dedov II, Shestakova MV, Mayorov AY, et al. Standards of specialized diabetes care. 9th edition. Diabetes mellitus. 2019;22(1S). (In Russ.)] doi: https://doi.org/10.14341/DM221S1Болевые синдромы в неврологической практике. / Под ред. Вейна А.М. — М.; 2001. [Veyn AM, editor. Bolevye sindromy v nevrologicheskoy praktike. Moscow; 2001. (In Russ.)]Болевые синдромы в неврологической практике. / Под ред. Вейна А.М. — М.; 2001. [Veyn AM, editor. Bolevye sindromy v nevrologicheskoy praktike. Moscow; 2001. (In Russ.)]Hansson P, Fields H, Hill R, Marchettini P, editors. Neuropathic Pain: Pathophysiology and Treatment, Progress in Pain Research and Management. Seattle: IASP Press; 2001.Hansson P, Fields H, Hill R, Marchettini P, editors. Neuropathic Pain: Pathophysiology and Treatment, Progress in Pain Research and Management. Seattle: IASP Press; 2001.Яхно Н.Н., Давыдов О.С. Неврологическая боль. Современное состояние проблемы. В кн.: Болезни мозга – медицинские и социальные аспекты / Под ред. Е.И. Гусева, А.Б Гехт. — М.: Буки-Веди, 2016. — C.605–627. [Yakhno NN, Davidov OS. Neuropathic pain. The current state of the problem. In: Gusev EI, Gecht AB, editors. Brain Diseases - Medical and Social Aspects. Moscow: Buki-Vedi; 2011. p.605–627. (In Russ.)]Яхно Н.Н., Давыдов О.С. Неврологическая боль. Современное состояние проблемы. В кн.: Болезни мозга – медицинские и социальные аспекты / Под ред. Е.И. Гусева, А.Б Гехт. — М.: Буки-Веди, 2016. — C.605–627. [Yakhno NN, Davidov OS. Neuropathic pain. The current state of the problem. In: Gusev EI, Gecht AB, editors. Brain Diseases - Medical and Social Aspects. Moscow: Buki-Vedi; 2011. p.605–627. (In Russ.)]Боль. Практическое руководство для врачей. / Под ред. Яхно Н.Н. — М.: Издательство РАМН АНО, 2011. [Yakhno NN, editor. Pain. Practical guide for doctors. Moscow: RAMN ANO; 2011. (In Russ.)]Боль. Практическое руководство для врачей. / Под ред. Яхно Н.Н. — М.: Издательство РАМН АНО, 2011. [Yakhno NN, editor. Pain. Practical guide for doctors. Moscow: RAMN ANO; 2011. (In Russ.)]van Hecke O, Austin SK, Khan RA et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662. doi: https://doi.org/10.1016/j.pain.2013.11.013van Hecke O, Austin SK, Khan RA et al. Neuropathic pain in the general population: a systematic review of epidemiological studies. Pain. 2014;155(4):654-662. doi: https://doi.org/10.1016/j.pain.2013.11.013DiBonaventura MD, Sadosky A, Concialdi K. The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey. J Pain Res. 2017;10:2525-2538. doi: https://doi.org/10.2147/JPR.S127014DiBonaventura MD, Sadosky A, Concialdi K. The prevalence of probable neuropathic pain in the US: results from a multimodal general-population health survey. J Pain Res. 2017;10:2525-2538. doi: https://doi.org/10.2147/JPR.S127014Яхно Н.Н., Кукушкин М.Л., Давыдов О.С. Результаты российского эпидемиологического исследования распространенности невропатической боли, ее причин и характеристик в популяции амбулаторных больных, обратившихся к врачу-неврологу // Боль. — 2008. — №3. — С. 24-32. [Yakhno NN, Kukushkin ML, Davidov OS. Rezul'taty rossijskogo jepidemiologicheskogo issledovanija rasprostranennosti nevropaticheskoj boli, ee prichin i harakteristik v populjacii ambulatornyh bol'nyh, obrativshihsja k vrachu-nevrologu. Bol’. 2008;(3):24-32. (In Russ.)]Яхно Н.Н., Кукушкин М.Л., Давыдов О.С. Результаты российского эпидемиологического исследования распространенности невропатической боли, ее причин и характеристик в популяции амбулаторных больных, обратившихся к врачу-неврологу // Боль. — 2008. — №3. — С. 24-32. [Yakhno NN, Kukushkin ML, Davidov OS. Rezul'taty rossijskogo jepidemiologicheskogo issledovanija rasprostranennosti nevropaticheskoj boli, ee prichin i harakteristik v populjacii ambulatornyh bol'nyh, obrativshihsja k vrachu-nevrologu. Bol’. 2008;(3):24-32. (In Russ.)]Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Сыровегин А.В. Результаты открытого мультицентрового исследования «МЕРИДИАН» по оценке распространенности болевых синдромов в амбулаторной практике и терапевтических предпочтений врачей // Российский журнал боли. — 2012. — №3-4. — С. 10-14. [Yahno NN, Kukushkin ML, Churyukanov MV, Syrovegin AV. The results of open multicentral study "Meridian" for assessment of pain syndromes prevalence in ambulatory and therapeutic preferences of physicians. Russian journal of pain. 2012;(3-4):10-14. (In Russ.)]Яхно Н.Н., Кукушкин М.Л., Чурюканов М.В., Сыровегин А.В. Результаты открытого мультицентрового исследования «МЕРИДИАН» по оценке распространенности болевых синдромов в амбулаторной практике и терапевтических предпочтений врачей // Российский журнал боли. — 2012. — №3-4. — С. 10-14. [Yahno NN, Kukushkin ML, Churyukanov MV, Syrovegin AV. The results of open multicentral study "Meridian" for assessment of pain syndromes prevalence in ambulatory and therapeutic preferences of physicians. Russian journal of pain. 2012;(3-4):10-14. (In Russ.)]Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154. doi: https://doi.org/10.2337/dc16-2042Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-154. doi: https://doi.org/10.2337/dc16-2042Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473. doi: https://doi.org/10.1007/s11910-014-0473-5Albers JW, Pop-Busui R. Diabetic neuropathy: mechanisms, emerging treatments, and subtypes. Curr Neurol Neurosci Rep. 2014;14(8):473. doi: https://doi.org/10.1007/s11910-014-0473-5Dyck PJ, Albers JW, Andersen H, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011;27(7):620-628. doi: https://doi.org/10.1002/dmrr.1226Dyck PJ, Albers JW, Andersen H, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011;27(7):620-628. doi: https://doi.org/10.1002/dmrr.1226Biessels GJ, Bril V, Calcutt NA, et al. Phenotyping animal models of diabetic neuropathy: a consensus statement of the diabetic neuropathy study group of the EASD (Neurodiab). J Peripher Nerv Syst. 2014;19(2):77-87. doi: https://doi.org/10.1111/jns5.12072Biessels GJ, Bril V, Calcutt NA, et al. Phenotyping animal models of diabetic neuropathy: a consensus statement of the diabetic neuropathy study group of the EASD (Neurodiab). J Peripher Nerv Syst. 2014;19(2):77-87. doi: https://doi.org/10.1111/jns5.12072O’Brien PD, Hinder LM, Sakowski SA, Feldman EL. ER stress in diabetic peripheral neuropathy: A new therapeutic target. Antioxid Redox Signal. 2014;21(4):621-633. doi: https://doi.org/10.1089/ars.2013.5807O’Brien PD, Hinder LM, Sakowski SA, Feldman EL. ER stress in diabetic peripheral neuropathy: A new therapeutic target. Antioxid Redox Signal. 2014;21(4):621-633. doi: https://doi.org/10.1089/ars.2013.5807Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol. 2011;7(10):573-583. doi: https://doi.org/10.1038/nrneurol.2011.137Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol. 2011;7(10):573-583. doi: https://doi.org/10.1038/nrneurol.2011.137Malik RA, Veves A, Tesfaye S, et al. Small fibre neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy. Diabetes Metab Res Rev. 2011;27(7):678-684. doi: https://doi.org/10.1002/dmrr.1222Malik RA, Veves A, Tesfaye S, et al. Small fibre neuropathy: role in the diagnosis of diabetic sensorimotor polyneuropathy. Diabetes Metab Res Rev. 2011;27(7):678-684. doi: https://doi.org/10.1002/dmrr.1222Baron R, Tolle TR, Gockel U, et al. A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: Differences in demographic data and sensory symptoms. Pain. 2009;146(1-2):34-40. doi: https://doi.org/10.1016/j.pain.2009.06.001Baron R, Tolle TR, Gockel U, et al. A cross-sectional cohort survey in 2100 patients with painful diabetic neuropathy and postherpetic neuralgia: Differences in demographic data and sensory symptoms. Pain. 2009;146(1-2):34-40. doi: https://doi.org/10.1016/j.pain.2009.06.001Freeman R, Baron R, Bouhassira D, et al. Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs. Pain. 2014;155(2):367-376. doi: https://doi.org/10.1016/j.pain.2013.10.023Freeman R, Baron R, Bouhassira D, et al. Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs. Pain. 2014;155(2):367-376. doi: https://doi.org/10.1016/j.pain.2013.10.023Daousi C, MacFarlane IA, Woodward A, et al. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21(9):976-982. doi: https://doi.org/10.1111/j.1464-5491.2004.01271.xDaousi C, MacFarlane IA, Woodward A, et al. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21(9):976-982. doi: https://doi.org/10.1111/j.1464-5491.2004.01271.xDavies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518-1522. doi: https://doi.org/10.2337/dc05-2228Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518-1522. doi: https://doi.org/10.2337/dc05-2228Ziegler D, Rathmann W, Dickhaus T, et al. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10(2):393-400. doi: https://doi.org/10.1111/j.1526-4637.2008.00555.xZiegler D, Rathmann W, Dickhaus T, et al. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10(2):393-400. doi: https://doi.org/10.1111/j.1526-4637.2008.00555.xVileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic Peripheral Neuropathy and Depressive Symptoms: The association revisited. Diabetes Care. 2005;28(10):2378-2383. doi: https://doi.org/10.2337/diacare.28.10.2378Vileikyte L, Leventhal H, Gonzalez JS, et al. Diabetic Peripheral Neuropathy and Depressive Symptoms: The association revisited. Diabetes Care. 2005;28(10):2378-2383. doi: https://doi.org/10.2337/diacare.28.10.2378Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev. 2004;20 Suppl 1:S13-18. doi: https://doi.org/10.1002/dmrr.437Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev. 2004;20 Suppl 1:S13-18. doi: https://doi.org/10.1002/dmrr.437Vinik E, Silva MP, Vinik AI. Measuring the relationship of quality of life and health status, including tumor burden, symptoms, and biochemical measures in patients with neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40(1):97-109, viii. doi: https://doi.org/10.1016/j.ecl.2010.12.008Vinik E, Silva MP, Vinik AI. Measuring the relationship of quality of life and health status, including tumor burden, symptoms, and biochemical measures in patients with neuroendocrine tumors. Endocrinol Metab Clin North Am. 2011;40(1):97-109, viii. doi: https://doi.org/10.1016/j.ecl.2010.12.008Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic Somatic Neuropathies. Diabetes Care. 2004;27(6):1458-1486. doi: https://doi.org/10.2337/diacare.27.6.1458Boulton AJM, Malik RA, Arezzo JC, Sosenko JM. Diabetic Somatic Neuropathies. Diabetes Care. 2004;27(6):1458-1486. doi: https://doi.org/10.2337/diacare.27.6.1458Perkins BA, Olaleye D, Zinman B, Bril V. Simple Screening Tests for Peripheral Neuropathy in the Diabetes Clinic. Diabetes Care. 2001;24(2):250-256. doi: https://doi.org/10.2337/diacare.24.2.250Perkins BA, Olaleye D, Zinman B, Bril V. Simple Screening Tests for Peripheral Neuropathy in the Diabetes Clinic. Diabetes Care. 2001;24(2):250-256. doi: https://doi.org/10.2337/diacare.24.2.250Tan LS. The clinical use of the 10g monofilament and its limitations: a review. Diabetes Res Clin Pract. 2010;90(1):1-7. doi: https://doi.org/10.1016/j.diabres.2010.06.021Tan LS. The clinical use of the 10g monofilament and its limitations: a review. Diabetes Res Clin Pract. 2010;90(1):1-7. doi: https://doi.org/10.1016/j.diabres.2010.06.021Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679-1685. doi: https://doi.org/10.2337/dc08-9021Boulton AJ, Armstrong DG, Albert SF, et al. Comprehensive foot examination and risk assessment: a report of the task force of the foot care interest group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care. 2008;31(8):1679-1685. doi: https://doi.org/10.2337/dc08-9021Archer AG, Watkins PJ, Thomas PK, et al. The natural history of acute painful neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry. 1983;46(6):491-499. doi: https://doi.org/10.1136/jnnp.46.6.491Archer AG, Watkins PJ, Thomas PK, et al. The natural history of acute painful neuropathy in diabetes mellitus. J Neurol Neurosurg Psychiatry. 1983;46(6):491-499. doi: https://doi.org/10.1136/jnnp.46.6.491Boulton AJM, Vinik AI, Arezzo JC, et al. Diabetic Neuropathies: A statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-962. doi: https://doi.org/10.2337/diacare.28.4.956Boulton AJM, Vinik AI, Arezzo JC, et al. Diabetic Neuropathies: A statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-962. doi: https://doi.org/10.2337/diacare.28.4.956Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-2293. doi: https://doi.org/10.2337/dc10-1303Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285-2293. doi: https://doi.org/10.2337/dc10-1303Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015;138(Pt 1):43-52. doi: https://doi.org/10.1093/brain/awu307Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain. 2015;138(Pt 1):43-52. doi: https://doi.org/10.1093/brain/awu307Старостина Е.Г. Диабетическая нейропатия: некоторые вопросы дифференциальной диагностики и системной терапии болевого синдрома // РМЖ. — 2017. — Т. 25. — №22. — С. 3-14. [Starostina EG. Diabetic neuropathy: some issues in differential diagnosis and systemic treatment of the pain syndrome. RMZh. 2017;25(22):2-14. (In Russ.)]Старостина Е.Г. Диабетическая нейропатия: некоторые вопросы дифференциальной диагностики и системной терапии болевого синдрома // РМЖ. — 2017. — Т. 25. — №22. — С. 3-14. [Starostina EG. Diabetic neuropathy: some issues in differential diagnosis and systemic treatment of the pain syndrome. RMZh. 2017;25(22):2-14. (In Russ.)]Diabetes Control and Complications Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. doi: https://doi.org/10.1056/NEJM199309303291401Diabetes Control and Complications Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329(14):977-986. doi: https://doi.org/10.1056/NEJM199309303291401Diabetes Control and Complications Research Group. Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol. 1995;38(6):869-880. doi: https://doi.org/10.1002/ana.410380607Diabetes Control and Complications Research Group. Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol. 1995;38(6):869-880. doi: https://doi.org/10.1002/ana.410380607Linn T, Ortac K, Laube H, Federlin K. Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve: A randomized, controlled, prospective study over 5 years in newly diagnosed patients. Metabolism. 1996;45(12):1508-1513. doi: https://doi.org/10.1016/s0026-0495(96)90180-8Linn T, Ortac K, Laube H, Federlin K. Intensive therapy in adult insulin-dependent diabetes mellitus is associated with improved insulin sensitivity and reserve: A randomized, controlled, prospective study over 5 years in newly diagnosed patients. Metabolism. 1996;45(12):1508-1513. doi: https://doi.org/10.1016/s0026-0495(96)90180-8Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11(6):521-534. doi: https://doi.org/10.1016/s1474-4422(12)70065-0Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11(6):521-534. doi: https://doi.org/10.1016/s1474-4422(12)70065-0Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419-430. doi: https://doi.org/10.1016/s0140-6736(10)60576-4Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419-430. doi: https://doi.org/10.1016/s0140-6736(10)60576-4Ohkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28(2):103-117. doi: https://doi.org/10.1016/0168-8227(95)01064-kOhkubo Y, Kishikawa H, Araki E, et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995;28(2):103-117. doi: https://doi.org/10.1016/0168-8227(95)01064-kIsmail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419-430. doi: https://doi.org/10.1016/S0140-6736(10)60576-4Ismail-Beigi F, Craven T, Banerji MA, et al. Effect of intensive treatment of hyperglycaemia on microvascular outcomes in type 2 diabetes: an analysis of the ACCORD randomised trial. Lancet. 2010;376(9739):419-430. doi: https://doi.org/10.1016/S0140-6736(10)60576-4Charles M, Ejskjaer N, Witte DR, et al. Prevalence of neuropathy and peripheral arterial disease and the impact of treatment in people with screen-detected type 2 diabetes: the ADDITION-Denmark study. Diabetes Care. 2011;34(10):2244-2249. doi: https://doi.org/10.2337/dc11-0903Charles M, Ejskjaer N, Witte DR, et al. Prevalence of neuropathy and peripheral arterial disease and the impact of treatment in people with screen-detected type 2 diabetes: the ADDITION-Denmark study. Diabetes Care. 2011;34(10):2244-2249. doi: https://doi.org/10.2337/dc11-0903Charles M, Fleischer J, Witte DR, et al. Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study. Diabetologia. 2012;56(1):101-108. doi: https://doi.org/10.1007/s00125-012-2744-5Charles M, Fleischer J, Witte DR, et al. Impact of early detection and treatment of diabetes on the 6-year prevalence of cardiac autonomic neuropathy in people with screen-detected diabetes: ADDITION-Denmark, a cluster-randomised study. Diabetologia. 2012;56(1):101-108. doi: https://doi.org/10.1007/s00125-012-2744-5Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528. doi: https://doi.org/10.1007/s11892-014-0528-7Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528. doi: https://doi.org/10.1007/s11892-014-0528-7Pop-Busui R, Lu J, Brooks MM, et al. Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Cohort. Diabetes Care. 2013;36(10):3208-3215. doi: https://doi.org/10.2337/dc13-0012Pop-Busui R, Lu J, Brooks MM, et al. Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Cohort. Diabetes Care. 2013;36(10):3208-3215. doi: https://doi.org/10.2337/dc13-0012Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-393. doi: https://doi.org/10.1056/NEJMoa021778Gaede P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348(5):383-393. doi: https://doi.org/10.1056/NEJMoa021778Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications. 2006;20(4):216-223. doi: https://doi.org/10.1016/j.jdiacomp.2005.07.005Balducci S, Iacobellis G, Parisi L, et al. Exercise training can modify the natural history of diabetic peripheral neuropathy. J Diabetes Complications. 2006;20(4):216-223. doi: https://doi.org/10.1016/j.jdiacomp.2005.07.005Singleton JR, Marcus RL, Jackson JE, et al. Exercise increases cutaneous nerve density in diabetic patients without neuropathy. Ann Clin Transl Neurol. 2014;1(10):844-849. doi: https://doi.org/10.1002/acn3.125Singleton JR, Marcus RL, Jackson JE, et al. Exercise increases cutaneous nerve density in diabetic patients without neuropathy. Ann Clin Transl Neurol. 2014;1(10):844-849. doi: https://doi.org/10.1002/acn3.125Carnethon MR, Prineas RJ, Temprosa M, et al. The Association Among Autonomic Nervous System Function, Incident Diabetes, and Intervention Arm in the Diabetes Prevention Program. Diabetes Care. 2006;29(4):914-919. doi: https://doi.org/10.2337/diacare.29.04.06.dc05-1729Carnethon MR, Prineas RJ, Temprosa M, et al. The Association Among Autonomic Nervous System Function, Incident Diabetes, and Intervention Arm in the Diabetes Prevention Program. Diabetes Care. 2006;29(4):914-919. doi: https://doi.org/10.2337/diacare.29.04.06.dc05-1729Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294-1299. doi: https://doi.org/10.2337/dc06-0224Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294-1299. doi: https://doi.org/10.2337/dc06-0224Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: high-dose monotherapy or their combination? The «COMBO-DN study»--a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain. 2013;154(12):2616-2625. doi: https://doi.org/10.1016/j.pain.2013.05.043Tesfaye S, Wilhelm S, Lledo A, et al. Duloxetine and pregabalin: high-dose monotherapy or their combination? The «COMBO-DN study»--a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain. 2013;154(12):2616-2625. doi: https://doi.org/10.1016/j.pain.2013.05.043Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173. doi: https://doi.org/10.1016/S1474-4422(14)70251-0Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162-173. doi: https://doi.org/10.1016/S1474-4422(14)70251-0Приказ МЗ РФ от 30.06.2015 № 386н «О внесении изменений в приложения к приказу Министерства здравоохранения Российской Федерации от 20 декабря 2012 г. №1175н «Об утверждении порядка назначения и выписывания лекарственных препаратов, а также форм рецептурных бланков на лекарственные препараты, порядка оформления указанных бланков, их учета и хранения»». [Order of the Ministry of Health of the Russian Federation of 30 Jun 2015 № 386н «O vnesenii izmeneniy v prilozheniya k prikazu Ministerstva zdravookhraneniya Rossiyskoy Federatsii ot 20 dekabrya 2012 g. №1175n «Ob utverzhdenii poryadka naznacheniya i vypisyvaniya lekarstvennykh preparatov, a takzhe form retsepturnykh blankov na lekarstvennye preparaty, poryadka oformleniya ukazannykh blankov, ikh ucheta i khraneniya»». (In Russ.)]Приказ МЗ РФ от 30.06.2015 № 386н «О внесении изменений в приложения к приказу Министерства здравоохранения Российской Федерации от 20 декабря 2012 г. №1175н «Об утверждении порядка назначения и выписывания лекарственных препаратов, а также форм рецептурных бланков на лекарственные препараты, порядка оформления указанных бланков, их учета и хранения»». [Order of the Ministry of Health of the Russian Federation of 30 Jun 2015 № 386н «O vnesenii izmeneniy v prilozheniya k prikazu Ministerstva zdravookhraneniya Rossiyskoy Federatsii ot 20 dekabrya 2012 g. №1175n «Ob utverzhdenii poryadka naznacheniya i vypisyvaniya lekarstvennykh preparatov, a takzhe form retsepturnykh blankov na lekarstvennye preparaty, poryadka oformleniya ukazannykh blankov, ikh ucheta i khraneniya»». (In Russ.)]

The authors declare that there are no conflicts of interest present.