Diabetic neuropathy

Last updated: August 8, 2023

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Summarytoggle arrow icon

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.”

Epidemiologytoggle arrow icon

Epidemiological data refers to the US, unless otherwise specified.

Pathophysiologytoggle arrow icon

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

Diabetic peripheral neuropathytoggle arrow icon

Clinical featurestoggle arrow icon

Many individuals with diabetic peripheral neuropathy are asymptomatic and the condition is often detected only during screening or after complications develop. [7][8][9]

Approximately 50% of patients with diabetic peripheral neuropathy are asymptomatic. [7]

Differential diagnosestoggle arrow icon

Diagnosticstoggle arrow icon

Diabetic peripheral neuropathy is a diagnosis of exclusion. [7][8]

Managementtoggle arrow icon

Good glycemic control can prevent the onset and progression of diabetic neuropathy, but it cannot reverse existing nerve damage. [6]

Complicationstoggle arrow icon

Diabetic autonomic neuropathytoggle arrow icon

Diabetic autonomic neuropathy is a type of diabetic neuropathy characterized by damage to small fiber autonomic nerves; multiple organ systems are susceptible. [7]

Clinical featurestoggle arrow icon

Genitourinary autonomic neuropathy [6]

Cardiovascular autonomic neuropathy [6]

Patients with cardiovascular autonomic neuropathy are at increased risk for silent myocardial infarction, arrhythmias, and death. [6][7]

Gastrointestinal autonomic neuropathy [6]

Other autonomic neuropathies [7]

Diagnosticstoggle arrow icon

Managementtoggle arrow icon

Preventiontoggle arrow icon

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). [6]

Screening for diabetic peripheral neuropathy [7]

Screening for diabetic autonomic neuropathy [6][7]

Referencestoggle arrow icon

  1. $Contributor Disclosures - Diabetic neuropathy. None of the individuals in control of the content for this article reported relevant financial relationships with ineligible companies. For details, please review our full conflict of interest (COI) policy:.
  2. Pop-Busui R, Boulton AJM, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2016; 40 (1): p.136-154.doi: 10.2337/dc16-2042 . | Open in Read by QxMD
  3. Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, et al.. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes 2023. Diabetes Care. 2022; 46 (Supplement_1): p.S203-S215.doi: 10.2337/dc23-s012 . | Open in Read by QxMD
  4. Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019; 19 (10).doi: 10.1007/s11892-019-1212-8 . | Open in Read by QxMD
  5. Castelli G, Desai KM, Cantone RE. Peripheral Neuropathy: Evaluation and Differential Diagnosis.. Am Fam Physician. 2020; 102 (12): p.732-739.
  6. Hanewinckel R, van Oijen M, Ikram MA, van Doorn PA. The epidemiology and risk factors of chronic polyneuropathy. Eur J Epidemiol. 2015; 31 (1): p.5-20.doi: 10.1007/s10654-015-0094-6 . | Open in Read by QxMD
  7. Verrotti A, Prezioso G, Scattoni R, Chiarelli F. Autonomic Neuropathy in Diabetes Mellitus. Front Endocrinol (Lausanne). 2014; 5.doi: 10.3389/fendo.2014.00205 . | Open in Read by QxMD
  8. 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
  9. Vinik AI. Diabetic Sensory and Motor Neuropathy. N Engl J Med. 2016; 374 (15): p.1455-1464.doi: 10.1056/nejmcp1503948 . | Open in Read by QxMD
  10. 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
  11. 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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