Supporting evidence is of classes A B R

B. Neuropathy - Peripheral neuropathy is difficult to prevent and treat. Most patients with type 2 diabetes and peripheral neuropathy have few symptoms but are found on examination to have diminished reflexes and sensation. Sometimes neuropathy can be very painful, especially at night, with "pins-and-needles" numbness and tingling in a stocking-and-glove distribution. Absence of reflexes or decreased thermal, vibratory, proprioceptive or pain sensation may be noted on examination and confirm the diagnosis. Good glycemic control should be the first control to symptomatic neuropathy. Treatment with amitrip-tyline, nortriptyline, or trazodone in doses beginning at 25 mg at night and increasing to 75 mg may help some patients. Topical treatment with capsaicin, 0.025% cream three to four times per day, has also shown benefit. Carbamazepine, duloxatine and gabapentin may improve neuropathic pain also. These medications may provide symptomatic relief, but they do not improve the neuropathy (American Diabetes Association, 1999).

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