What criteria should I use to refer a patient with diabetic neuropathy for specialist assessment?

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 ¹,³.
• 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 ¹,³.
• 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 ².
• For other active diabetic foot problems, referral to the multidisciplinary foot care or foot protection service should occur within 1 working day for triage ².

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 ¹,²,³.