Diabetic neuropathy: the “anesthetized” complication

Diabetic peripheral neuropathy (DPN) is one of the most common complications of type 1 and type 2 diabetes. This microangiopathic complication is present in 50% of patients with more than 20 years of disease and approximately 18-30% of those who develop it produce painful neuropathy; it is present in 4%-18% of cases. The difficulty in the diagnosis of DPN is currently linked to the absence of a clinical-laboratory marker, such as microalbuminuria for nephropathy, and the need therefore for clinical evaluation by means of: history and objective examination analysed with a score; instrumental confirmation of the presence of fibre damage by studying the small and large nerve fibres. The clinical problem remains to diagnose as soon as possible: the absence of the complication; the presence of DPN in the dichotomous presentation of pain and anaesthesia, in most diabetic patients starting with those who have a longer duration of the disease. This would allow highlighting: patients at high ulcerative risk; those with the presence of important sensory-pain disorders to whom pain therapy should be best addressed. The review will attempt to describe the most recent advances on DPN and therefore also of its diagnosis and its treatment, which starts with lifestyle modification, optimal metabolic control, achieved not too aggressively, intervention on other risk factors, and antioxidant therapy. A more precise and distinct sensory profile of patients with DPN and painful DPN may help to identify those who will respond to one treatment rather than another. Detailed sensory profiles will then lead to tailored treatment for subgroups of patients with painful DPN.