Diabetic Neuropathy

Andrew J.M. Boultona'h, Rayaz A. Malikb a University of Manchester and b Manchester Royal Infirmary, Manchester, UK

Introduction and Classification

Diabetic neuropathy is one of the commonest late complications of diabetes and the international recognized definition is 'the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes, after exclusion of other causes'. Of all the long-term complications of diabetes, none affects so many organs or systems of the body as those conditions included under the term 'diabetic neuropathies'. Neuropathies have been described in patients with type 1, type 2 and secondary diabetes of differing causes, suggesting a common aetiological mechanism based upon chronic hyperglycaemia. All the neuropathies are characterized by a progressive loss of nerve fibres that can be assessed noninvasively by a variety of methods varying from a simple clinical neurological exam through more detailed quantitative sensory and autonomic testing to detailed electrophysiology.

The accurate assessment of symptoms, signs and objective manifestations of peripheral nerve dysfunction are of course essential in the diagnosis and management of neuropathy, though the approach will vary according to need. Thus whereas longitudinal clinical trials of putative new therapies require a detailed and structured approach as outlined above, such comprehensive investigation is not necessary for day-to-day clinical management.

The natural history of diabetic neuropathy remains ill defined, partly because of poor patient selection and variable criteria for the definition of neuropathy employed in previous studies. However, neuropathies many give rise to much suffering amongst diabetic patients, especially those with painful symptomatology and/or foot ulceration. The late sequelae of neuropathy include Charcot neuroarthropathy, foot ulceration and even amputation, although many of these are potentially preventable.

Table 1. Clinical classification of diabetic neuropathies

Polyneuropathy

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