2019年美國糖尿病學會針對糖尿病神經病變及糖尿病足之標準治療建議

Diabetic Neuropathy and Foot Care: Standards of Medical Care in Diabetes-2019

郝立智(Lyh-Jyh Hao) ； 楊純宜(Chwen-Yi Yang) ； 游新(Eugene Hsin Yu) ； 許琇雲(Hsiu-Yun Hsu) ； 沈盈佐(Ying-Tso Shen) ； 陳紘騰(Hong-Teng Chen) ； 譚宏斌(Hung-Pin Tan) ； 陳進旺(Chin-Wang Chen) ； 王志龍(Jue-Long Wang) ； 黃孟華(Meng-Hua Huang)

《內科學誌》 30卷6期 (2019/12) Pp. 368-379

https://doi.org/10.6314/JIMT.201912_30(6).02

摘要

糖尿病神經病變是一種具有不同臨床表現的異質性疾病組。對於糖尿病患者早期識別神經病變並做適當處理是重要的。治療糖尿病神經病變首先應做好血糖控制，第二是注意足部的護理，以防止潰瘍、感染和截肢。如果出現糖尿病周邊神經痛，建議使用amitriptyline、venlafaxine、duloxetine或pregabalin。如果單一藥品治療效果不佳的患者，建議採用兩種不同類別的藥品複合治療。替代療法包括辣椒素霜劑、利多卡因貼布、α－硫辛酸或經皮神經電刺激。本次標準治療建議新增了高壓氧療法用於糖尿病足潰瘍患者的文獻回顧，在目前研究上分別有肯定與否定的證據。根據療效和節省成本的潛在資料，gabapentin被列入治療糖尿病患者神經病變疼痛的藥物名單。胃輕癱部分包括對一些額外治療方式的討論。對糖尿病患者每次就診時檢查腳的建議進行了修改，只包括那些有潰瘍高風險的患者。仍然建議每個人每年定期檢查。

關鍵字

糖尿病周邊神經病變（Diabetic peripheral neuropathy, DPN） ； 糖尿病足潰瘍（Diabetic foot ulcers） ； 美國糖尿病學會（American diabetes association, ADA） ； 高壓氧治療（Hyperbaric oxygen therapy, HBOT）

並列摘要

The diabetic neuropathies are a heterogeneous group of disorders with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is required. The most important treatment of diabetic neuropathy is optimal glucose control. Foot care is crucial to prevent ulceration, infection, and amputation. For patients with painful diabetic neuropathy, we suggest initial therapy using either amitriptyline or venlafaxine, duloxetine or pregabalin. If patients fail with single drug therapy, it is recommended that the composite treatment using two different classes of drugs. Alternative replacement therapy, including capsaicin cream, lidocaine patch, α-lipoic acid or transcutaneous electrical nerve stimulation. A new section was added in this standard medical care to describe the mixed evidence on the use of hyperbaric oxygen therapy in people with diabetic foot ulcers. Gabapentin was added to the list of agents to be considered for the treatment of neuropathic pain in people with diabetes based on data on efficacy and the potential for cost savings. The gastroparesis section includes a discussion of a few additional treatment modalities. The recommendation for patients with diabetes to have their feet inspected at every visit was modified to only include those at high risk for ulceration. Annual examinations remain recommended for everyone.