Clinical Classification Of Diabetic Polyneuropathy

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Although clinical classification of the various syndromes of diabetic peripheral neuropathy are often difficult because of the very considerable overlap in the mixture of clinical features, attempts at classification stimulate thought as to the etiology of the various syndromes and also assist in the planning of management strategy for the patient. Watkins and Edmonds (9) have suggested a classification for diabetic polyneuropathy based on the natural history of the various syndromes, which clearly separates them into three distinct groups (Table 2).

Based on the various distinct clinical presentations to the physician, Ward recommended a classification of diabetic polyneuropathy depicted in Table 3 (10). This practical approach to the classification of diabetic neuropathies provides the clinician to have workable, crude definitions for the various neuropathic syndromes, and also assists in the management of the patient.

Another method of classifying diabetic polyneuropathy is by considering whether the clinical involvement is symmetrical or assymetrical. However, the separation to symmetrical and asymmetrical neuropathies, although useful in identifying distinct

Table 4

Classification of Diabetic Neuropathy

Symmetrical neuropathies

Distal sensory and sensori-motor neuropathy

Large-fiber type of diabetic neuropathy

Small-fiber type of diabetic neuropathy

Distal small-fiber neuropathy

"Insulin neuropathy"

Chronic inflammatory demyelinating polyradiculoneuropathy

Asymmetrical neuropathies


Mononeuropathy multiplex


Lumbar plexopathy or radiculoplexopathy

Chronic inflammatory demyelinating polyradiculoneuropathy

Adapted from ref. 13.

entities and perhaps providing clues to the varied aetiologies, is an oversimplification of the truth as there is a great overlapping of the syndromes. This method was originally suggested by Bruyn and Garland (11), and later modified by Thomas (12). More recently, Low and Suarez (13) have further modified this classification (Table 4).

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