Dr Kola Tytler MBBS CertHE MBA MRCGPClinical Lead • iatroX
Referral criteria for specialist assessment in patients with diabetic neuropathy include:
- Referral for chronic painful diabetic neuropathy should follow the guidance in the NICE guideline on neuropathic pain in adults, indicating specialist assessment when pain is persistent or difficult to manage in primary care NICE NG17,NICE NG28.
- Consider referral if autonomic neuropathy is suspected, especially when symptoms such as unexplained diarrhoea (particularly nocturnal), bladder emptying problems, or orthostatic hypotension occur, and when the diagnosis is uncertain or symptoms are severe NICE NG17,NICE NG28.
- For diabetic foot problems related to neuropathy, immediate referral to acute services and multidisciplinary foot care is required if there is a limb-threatening or life-threatening foot problem, such as ulceration with signs of sepsis, limb ischaemia, deep tissue or bone infection, or gangrene NICE NG19.
- For other active diabetic foot problems, referral to the multidisciplinary foot care or foot protection service should occur within 1 working day for triage NICE NG19.
In summary, patients with diabetic neuropathy should be referred for specialist assessment if they have chronic painful neuropathy not controlled in primary care, suspected autonomic neuropathy with significant symptoms, or any diabetic foot problem that is limb- or life-threatening or active requiring urgent specialist input NICE NG17,NICE NG19,NICE NG28.