Diabetic neuropathies

Introduction
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By Bashar Katirji MD

Neuropathies include a variety of disorders that afflict diabetics fairly exclusively and are characterized by variable degrees of peripheral nerve damage. In this review of diabetic neuropathies, the wide variety of types of peripheral nerve damage and the diversity of the resulting clinical syndromes is emphasized. In terms of arresting or reversing the commonest type, chronic diabetic sensory-motor polyneuropathy, unfortunately no progress has been made. Other types of neuropathy in the diabetic, such as proximal diabetic neuropathy and chronic inflammatory demyelinating neuropathy, sometimes respond to immunomodulatory and/or anti-inflammatory treatments. Several randomized controlled studies show the efficacy of some of the newer anticonvulsant medications such as pregabalin, or antidepressants, such as duloxetine, in the treatment of diabetic neuropathic pain.

  • Diabetes is the leading cause of peripheral polyneuropathy.
  • Peripheral nerve dysfunction in diabetics may be caused by other common causes of neuropathies.
  • Although chronic distal sensorimotor polyneuropathy is the most common type of diabetic neuropathy, other generalized and focal diabetic neuropathies are commonly encountered in neurologic clinical practice.
  • Optimal glucose control remains the most important prevention and treatment strategies in diabetic polyneuropathy.

In This Article

Introduction
Historical note and nomenclature
Clinical manifestations
Clinical vignette
Etiology
Epidemiology
Prevention
Differential diagnosis
Diagnostic workup
Prognosis and complications
Management
References cited
Contributors