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Diabetic Neuropathy

Neda Frayha, MD and Harpreet Tsui, DO
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When a patient with poorly controlled diabetes presents with numbness and tingling in their feet, how well do we really know what to do next? To help us understand diabetic neuropathy a bit better, Dr. Harpreet Tsui joins Neda to discuss screening, diagnosis, and treatment pearls.

 

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Kevin B., Mr. -

You recommend pregabalin as a first line therapy for diabetic neuropathy. However almost all insurances will not approve this med until you max out on gabapentin? Some patients do not tolerate even a small dose of gabapentin. How do you et around this, I have found prior authoriazation will still not okay pregabalin with our use of gabapentin first?

Neda F., MD -

Hi Kevin. Here is Dr. Tsui's response: "I agree for pregabalin approval, I often have to trial a patient on gabapentin first. So while the guidelines for diabetic neuropathy list pregabalin as first-line, the insurance companies dictate what they cover. If a patient cannot even tolerate gabapentin 100mg, I will write that in my prior authorization. I’ve had to go back and forth with the insurance companies but usually get pregabalin covered for some time."

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Primary Care RAP Written Summary April 2020 1 MB - PDF

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