Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10-g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South-East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug-induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B1 , B6 , B12 , D) should be actively excluded.
Prediabetes and diabetes burden become the strong challenge in the Western Pacific region. Prediabetes with impaired fasting glucose (IFG), impaired glucose tolerance (IGT) and the mixed status (IFG + IGT) are considered as risk factors for the development of diabetes. Effective early intervention for prediabetes can significantly delay the progression of the onset of diabetes, even if reverse blood glucose to normal. Increasing evidence shows that without targeted intervention, the progression from prediabetes to diabetes occurs more frequently in Asians compared with Caucasians. Consequently, it is essential to timely detect the populations at higher risk and effectively implement intervention and management to prevent diabetes. Significant evidence also supports the effectiveness of adjusting lifestyle in combination with medication to delay the onset of diabetes. A working group of Western Pacific expertise in diabetes conducted to develop evidence-based consensus recommendations to guide the management of patients with prediabetes. These consensual recommendations are intended to provide a clear and concise approach to the management of individuals with prediabetes.