Diabetes Care 2 January ; 47 1 : 17β Psychological factors and psychosocial care for individuals with diabetic neuropathy DN , a common and burdensome complication of diabetes, are important but overlooked areas. In this article we focus on common clinical manifestations of DN, unremitting neuropathic pain, postural instability, and foot complications, and their psychosocial impact, including depression, anxiety, poor sleep quality, and specific problems such as fear of falling and fear of amputation.
We also summarize the evidence regarding the negative impact of psychological factors such as depression on DN, self-care tasks, and future health outcomes. The clinical problem of underdetection and undertreatment of psychological problems is described, together with the value of using brief assessments of these in clinical care. We conclude by discussing trial evidence regarding the effectiveness of current pharmacological and nonpharmacological approaches and also future directions for developing and testing new psychological treatments for DN and its clinical manifestations.
Diabetes adversely affects multiple organ systems and is an important contributor to chronic complications and increased mortality rates. Recent estimates suggest that worldwide, million people are affected by diabetes 1. In the U. DSPN is characterized by distal to proximal sensory nerve dysfunction with a multitude of symptoms including numbness, tingling, loss of protective sensation, and poor balance 6.
Additionally, one-third of those with DSPN often experience debilitating neuropathic pain symptoms 6. DSPN is also the leading cause of diabetic foot ulceration, Charcot neuroarthropathy CN , and lower limb amputations 6.
Similarly, diabetic autonomic neuropathy may also have a broad spectrum of clinical manifestations including cardiovascular autonomic neuropathy, gastrointestinal autonomic dysfunction, and urinogenital manifestations such as male and female sexual dysfunction. Whether present alone or in combination, these symptoms and signs have been shown to be associated with elevated risk for serious cardiovascular outcomes, higher mortality rates, impaired psychological well-being, and lower quality of life QoL 7.
