Diabetic neuropathy is a most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care [1,2]. It is the most common form of neuropathy in the developed countries of the world, accounts for more admission to hospital than all the other diabetic complications combined and is responsible for 50±75 % of non-traumatic amputations [2,3]. Diabetic neuropathy is a set of clinical syndromes that affect distinct regions of the nervous system, singly or combined. It can be silent and go undetected, while exercising its ravages, or be present with clinical symptoms and signs that although non-specific and insidious with slow progression also mimic those seen in many other diseases. It is, therefore, diagnosed by exclusion.Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous systems. For these reasons, it has been difficult to obtain precise estimates of the true prevalence and reports vary from 10 to 90 % in diabetic patients, depending on the criteria and methods used to define neuropathy [1±5]. From patients attending a diabetes clinic 25 % reported symptoms; 50 % were found to have neuropathy after a simple clinical test such as the ankle jerk or vibration perception test; almost 90 % tested positive to sophisticated tests of autonomic function or peripheral sensation [6]. Neurologic complications occur equally in Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus and additionally in various forms of acquired diabetes [5]. The major morbidity associated with somatic neuropathy is foot ulceration, the precursor of gangrene and limb loss. Neuropathy increases the risk of amputation 1.7-fold; 12-fold, if there is deformity (itself a consequence of neuropathy), and 36-fold, if there is a history of previous ulceration [7]. There are 65,000 amputations in the United States each year, one every 10 min, and neuropathy is considered to be the major contributor in 87 % of cases. It is also the most life-spoiling of the diabetic complications and has tremendous ramifications for the quality of life of the person with diabetes. Once autonomic neuropathy sets in, life can become quite dismal and the mortality rate approximates 25±50 % within 5±10 years [8,9]. In this review we present and discuss the most recent approaches to the diagnosis and treatment of diabetic neuropathy and the prospects on the horizon. ClassificationDiabetic neuropathy is not a single entity but a number of different syndromes, ranging from subclinical to clinical manifestations depending on the classes of nerve fibres involved. According to the San Antonio Convention [10], the main groups of neurologic disturbance in diabetes mellitus include: (1) subclinical neuropathy, determined by abnormalities in electrodiagnostic and quantitative sensory testing, (2) dif- Diabetologia (2000) 43:...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.