Diabetic neuropathy

Last updated: February 10, 2023

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Diabetic neuropathy is a progressive nerve injury caused by chronic hyperglycemia. Distal symmetric polyneuropathy and autonomic neuropathy are the most common types; less common manifestations include mononeuropathy and radiculopathy. Patients with distal symmetric polyneuropathy typically present with sensory loss of the lower extremities and may also have motor weakness, although many affected individuals are asymptomatic. Diagnosis is typically clinical, and management includes glycemic control and daily foot care. Pharmacological therapy may be considered for pain management. In diabetic autonomic neuropathy, clinical presentation, recommended diagnostic studies, and treatment vary depending on the organ system involved. Annual screening for diabetic neuropathy is recommended for all patients with diabetes, starting at the time of diagnosis for patients with type 2 diabetes mellitus (T2DM) and 5 years after diagnosis for patients with type 1 diabetes mellitus (T1DM).

See also “Diabetic gastroparesis.”

Epidemiological data refers to the US, unless otherwise specified.

Chronic hyperglycemia causes glycation of axon proteins and subsequent development of progressive sensomotor neuropathy; typically affects multiple peripheral nerves.

Many individuals with diabetic peripheral neuropathy are asymptomatic and the condition is often detected only during screening or after complications develop. [6][7][8]

Approximately 50% of patients with diabetic peripheral neuropathy are asymptomatic. [6]

Diabetic peripheral neuropathy is a diagnosis of exclusion. [6][7]

Good glycemic control can prevent the onset and progression of diabetic neuropathy, but it cannot reverse existing nerve damage. [5]

Diabetic autonomic neuropathy is a type of diabetic neuropathy characterized by damage to small fiber autonomic nerves; multiple organ systems are susceptible. [6]

Genitourinary autonomic neuropathy [5]

Cardiovascular autonomic neuropathy [5]

Patients with cardiovascular autonomic neuropathy are at increased risk for silent myocardial infarction, arrhythmias, and death. [5][6]

Gastrointestinal autonomic neuropathy [5]

Other autonomic neuropathies [6]

Screening for diabetic neuropathy

Perform annually, starting at the time of diagnosis for patients with T2DM and 5 years after diagnosis for patients with T1DM (earlier if symptoms develop). [5]

Screening for diabetic peripheral neuropathy [6]

Screening for diabetic autonomic neuropathy [5][6]

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  7. Pop-Busui R, Ang L, Boulton A, et al. Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy. ADA Clinical Compendia. 2022; 2022 (1): p.1-32. doi: 10.2337/db2022-01 . | Open in Read by QxMD
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  9. Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary. Neurology. 2021; 98 (1): p.31-43. doi: 10.1212/wnl.0000000000013038 . | Open in Read by QxMD
  10. Jain M, Devan S, Jaisankar D, Swaminathan G, Pardhan S, Raman R. Pupillary Abnormalities with Varying Severity of Diabetic Retinopathy. Scientific Reports. 2018; 8 (1). doi: 10.1038/s41598-018-24015-9 . | Open in Read by QxMD

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