Research on the epidemiology of diabetic neuropathy is at an earlier stage in comparison with other diabetic complications. Considerable advances would occur in this field if standardized definitions were developed and used in multiple investigations, although care should be taken to avoid protocols that would be burdensome to study participants, because these would increase the likelihood of bias because of unac-ceptably low participation rates. Also, measurement methods should be used which easily translate into clinical practice. Important potential confounding variables must be considered in future studies, including alcohol consumption in particular, height, and possibly nutritional factors as well. Further investigation of the association between hyperlipidemia and risk of neuropathy is warranted to examine the possibility that this complication may have, in part, a macrovascular etiology. Prospective studies of large cohorts of diabetic subjects would likely yield the best quality information concerning potential causative risk factors for diabetic neuropathy. Because of the low frequency of occurrence of diabetic focal neuropathies, the case-control approach would be best suited to identify risk factors for these outcomes. One can hope that these efforts will lead to better methods to prevent this difficult to manage complication of DM.
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