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Diabetic neuropathy—a review

Abstract

Diabetic neuropathy is the most common neuropathy in industrialized countries, and it is associated with a wide range of clinical manifestations. The vast majority of patients with clinical diabetic neuropathy have a distal symmetrical form of the disorder that progresses following a fiber-length-dependent pattern, with sensory and autonomic manifestations predominating. This pattern of neuropathy is associated with a progressive distal axonopathy. Patients experience pain, trophic changes in the feet, and autonomic disturbances. Occasionally, patients with diabetes can develop focal and multifocal neuropathies that include cranial nerve involvement and limb and truncal neuropathies. This neuropathic pattern tends to occur after 50 years of age, and mostly in patients with long-standing diabetes mellitus. Length-dependent diabetic polyneuropathy does not show any trend towards improvement, and either relentlessly progresses or remains relatively stable over a number of years. Conversely, the focal diabetic neuropathies, which are often associated with inflammatory vasculopathy on nerve biopsies, remain self-limited, sometimes after a relapsing course.

Key Points

  • Length-dependent peripheral neuropathy is a common complication of diabetes, and carries a high risk of pain, trophic changes and autonomic dysfunction

  • Optimum glycemic control is the best preventive treatment for diabetic neuropathy

  • Inflammatory lesions are common in focal and multifocal neuropathies

  • If motor deficit or proprioceptive involvement predominates, it is important to consider nondiabetic causes of neuropathy

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Figure 1: Nerve biopsy findings in length-dependent diabetic polyneuropathy
Figure 2: Abnormalities of unmyelinated fibers in severe length-dependent diabetic polyneuropathy
Figure 3: Abnormalities of isolated fibers in length-dependent diabetic polyneuropathy
Figure 4: Multifocal diabetic neuropathy

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Said, G. Diabetic neuropathy—a review. Nat Rev Neurol 3, 331–340 (2007). https://doi.org/10.1038/ncpneuro0504

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