A Pragmatic Approach to Improving Management and Patient Flow for Painful Diabetic Neuropathy in UK Primary Care.

Abstract

Introduction: Painful diabetic peripheral neuropathy (pDPN) affects approximately 25% of individuals with diabetes in the UK and remains underdiagnosed and suboptimally managed in primary care. The condition causes chronic pain, limits daily functioning, impairs quality of life, and increases the risk of complications like foot ulcers and amputations due to underlying neuropathy. Current care pathways are fragmented, leading to delays in diagnosis and limited access to evidence-based therapies. This article aims to address the challenges of screening, diagnosis, and management of pDPN in UK primary care by proposing a consensus-driven, five-step pragmatic strategy.

Methods: An expert panel of general practitioners and a diabetes nurse practitioner from across the UK convened to review and discuss strategies for improving pDPN care. Consensus was reached through an evaluation of barriers in clinical practice, supported by real-world experience and examples of innovative care delivery models, resulting in the development of practical recommendations and workflow.

Results: Key barriers identified include insufficient training of healthcare professionals in pDPN, underutilisation of validated screening tools such as the DN4 questionnaire, and inconsistent and outdated treatment guidelines. To address these challenges, a five-step approach was proposed to include screening high-risk patients using validated questionnaires, following up on these patients to enable early diagnoses, initiating early treatments with first-line therapies while monitoring responses, referring complex cases to secondary care on the basis of structured criteria, and ensuring coordinated follow-up to streamline and optimise care delivery. Case studies demonstrate the practical application of these strategies in improving early detection, treatment adherence, and long-term care for individuals with pDPN.

Conclusion: Current practices have fallen short in providing adequate care for one in four individuals with diabetes. Implementing a straightforward five-step approach can significantly improve diagnostic accuracy and treatment outcomes, reducing the burden of pDPN on both patients and society.