应在以下患者中进行周围神经病变的筛查：
2 型糖尿病，诊断后
代谢综合征或葡萄糖耐量受损，诊断后
1 型糖尿病，诊断后 5 年。
此后至少每年根据症状和体征进行一次筛查（简单的临床评估包括针刺感、振动知觉 [128-Hz 音叉]、
[Figure caption and citation for the preceding image starts]: 振动试验由 BMJ 集团创建 [Citation ends].轻触知觉 [10-g 单尼龙丝]、
[Figure caption and citation for the preceding image starts]: 单尼龙丝轻触试验由 BMJ 集团创建 [Citation ends].及踝反射）。[55]American Diabetes Association. 9. Microvascular complications and foot care. Diabetes Care. 2015;38(suppl 1):S58-S66.http://care.diabetesjournals.org/content/38/Supplement_1/S58.longhttp://www.ncbi.nlm.nih.gov/pubmed/25537710?tool=bestpractice.com密歇根神经病变筛查工具 (MNSI) 和类似的症状评分系统在临床研究中很有帮助。[99]Feldman EL, Stevens MJ, Thomas PK, et al. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17:1281-1289.http://www.ncbi.nlm.nih.gov/pubmed/7821168?tool=bestpractice.com[100]Young MJ, Adams JE, Anderson GF, et al. Medial arterial calcification in the feet of diabetic patients and matched non-diabetic control subjects. Diabetologia. 1993;36:615-621.http://www.ncbi.nlm.nih.gov/pubmed/8359578?tool=bestpractice.com[101]Cabezas-Cerrato J. The prevalence of clinical diabetic polyneuropathy in Spain: a study in primary care and hospital clinic groups. Neuropathy Spanish Study Group of the Spanish Diabetes Society (SDS). Diabetologia. 1998;41:1263-1269.http://www.ncbi.nlm.nih.gov/pubmed/9833931?tool=bestpractice.com[102]Herman WH, Pop-Busui R, Braffett BH, et al; DCCT/EDIC Research Group. Use of the Michigan Neuropathy Screening Instrument as a measure of distal symmetrical peripheral neuropathy in Type 1 diabetes: results from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications. Diabet Med. 2012;29:937-944.http://www.ncbi.nlm.nih.gov/pubmed/22417277?tool=bestpractice.com
仅在临床特征不典型的情况下方才需要进行电生理检查或转诊至神经科医生处：[55]American Diabetes Association. 9. Microvascular complications and foot care. Diabetes Care. 2015;38(suppl 1):S58-S66.http://care.diabetesjournals.org/content/38/Supplement_1/S58.longhttp://www.ncbi.nlm.nih.gov/pubmed/25537710?tool=bestpractice.com
运动缺陷大于感觉缺陷
显著的不对称性神经功能障碍
上肢首发症状
快速进展。
美国糖尿病协会建议在病史采集和体格检查中筛查自主神经病变的体征和症状。[55]American Diabetes Association. 9. Microvascular complications and foot care. Diabetes Care. 2015;38(suppl 1):S58-S66.http://care.diabetesjournals.org/content/38/Supplement_1/S58.longhttp://www.ncbi.nlm.nih.gov/pubmed/25537710?tool=bestpractice.com极少需要进行特殊试验，可能不会影响治疗或结局。
心血管自主神经病变 (cardiovascular autonomic neuropathy, CAN) 筛查[22]Spallone V, Ziegler D, Freeman R, et al; Toronto Consensus Panel on Diabetic Neuropathy. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011;27:639-653.http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1239/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21695768?tool=bestpractice.com[58]Pop-Busui R. What do we know and we do not know about cardiovascular autonomic neuropathy in diabetes. J Cardiovasc Transl Res. 2012;5:463-478.http://www.ncbi.nlm.nih.gov/pubmed/22644723?tool=bestpractice.com[59]Pop-Busui R. Cardiac autonomic neuropathy in diabetes: a clinical perspective. Diabetes Care. 2010;33:434-441.http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2809298/http://www.ncbi.nlm.nih.gov/pubmed/20103559?tool=bestpractice.com[80]Bernardi L, Spallone V, Stevens M, et al; Toronto Consensus Panel on Diabetic Neuropathy. Methods of investigation for cardiac autonomic function in human research studies. Diabetes Metab Res Rev. 2011;27:654-664.http://onlinelibrary.wiley.com/doi/10.1002/dmrr.1224/fullhttp://www.ncbi.nlm.nih.gov/pubmed/21695761?tool=bestpractice.com
CAN 的诊断基于心血管反射试验 (CART)，该试验评估深呼吸、站立和 Valsalva 手法时的心率反应及站起时的血压反应。
心血管自主神经病变的诊断和监测需要一种以上的心血管反射试验和血压试验。
心血管反射试验的操作应标准化，并最大程度减小混杂因素的影响。
需严格要求对心率试验建立根据年龄校正的正常范围。
心血管自主神经病变的分期：
第 1 阶段：可能的或早期心血管自主神经病变：出现一种异常心血管反射试验，需随时间逐渐确诊
第 2 阶段：明确或确诊的心血管自主神经病变：要求至少有两种异常心血管反射试验
第 3 阶段：严重或晚期心血管自主神经病变：出现明确的心血管自主神经病变及直立性低血压 (Orthostatic hypotension, OH)
心血管自主神经病变阶段越晚，预后越差。
