Introduction

Diabetes mellitus is characterized in the later stages of the disease by several chronic disorders often termed "diabetic complications." These diabetic complications arise from a combination of factors including genetic, metabolic, and vascular factors. Diabetic neuropathy is one of the most common diabetes complications, but remains the least understood (1). The prevalence of diabetic neuropathy varies according to duration of diabetes ranging from 10% within 1 year of diagnosis to more than 50% after 25 years of the disease (2-4). Diabetic neuropathy is a heterogeneous condition that includes acute reversible syndromes as well as a chronic disease state (5-7). This heterogeneity strongly implicates multiple factors contributing to the disease process (8).

The environmental factors that have been associated with the susceptibility, development, and progression of diabetic microvascular complications include gender, HLA type, age at onset of diabetes mellitus, duration of disease, degree of metabolic control, pubertal development, growth hormone secretion, and presence of proteinuria as well as C-peptide (9-14). There are several metabolic and vascular pathways that have been identified as contributors to the pathogenesis of diabetic neuropathy. These include increased flux through the polyol pathway, nonenzymatic glycosylation, altered neu-rotrophism, insulin and C-peptide action, activation of protein kinase-C, apoptosis, and oxidative-nitrosative stress. Gene expression promoters such as transforming growth factors-a, vascular endothelial growth factors (VEGF) and the transcription factor nuclear factor-KB (NF-kB) have attracted a great deal of interest (Fig. 1).

From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ

Nitrosative Stress
Fig. 1. Hyperglycemia-induced metabolic abnormalities because of increased flux through the polyol pathway.
Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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