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Accordingly, the present expert panel suggests that DPN should be considered in a patient with prediabetes or diabetes who presents with neuropathic symptoms (involve both sides symmetrically) and/or signs of neuropathy in the presence of DPN risk factors (i.e., advancing age, obesity, hypertension, dyslipidemia, poor glycemic control), with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction only in atypical cases

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Clinical response=reduction in complete Mayo Score of 3 points and 30% from baseline with an accompanying decrease in rectal bleeding subscore of 1 point or absolute rectal bleeding subscore of 1 point