Key result
Diabetic neuropathy primarily presents as distal symmetrical neuropathy managed with glycemic control and symptomatic treatments.
This review outlines the classification, diagnosis, and management strategies for diabetic neuropathy.
Supports current diabetic neuropathy management; leaves open need for disease-modifying therapies in prospective trials.
Diabetic neuropathy (DN) refers to symptoms and signs of neuropathy in a patient with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the commonest accounting for 75% DN. Asymmetrical neuropathies may involve cranial nerves, thoracic or limb nerves; are of acute onset resulting from ischaemic infarction of vasa nervosa. Asymmetric neuropathies in diabetic patients should be investigated for entrapment neuropathy. Diabetic amyotrophy, initially considered to result from metabolic changes, and later ischaemia, is now attributed to immunological changes. For diagnosis of DN, symptoms, signs, quantitative sensory testing, nerve conduction study, and autonomic testing are used; and two of these five are recommended for clinical diagnosis. Management of DN includes control of hyperglycaemia, other cardiovascular risk factors; alpha lipoic acid and L carnitine. For neuropathic pain, analgesics, non-steroidal anti-inflammatory drugs, antidepressants, and anticonvulsants are recommended. The treatment of autonomic neuropathy is symptomatic.
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Bansal et al. (2006) conducted a review in Diabetic neuropathy. Diabetic neuropathy is primarily distal symmetrical neuropathy, diagnosed clinically using symptoms, signs, and testing, and managed through glycemic control and symptomatic treatments.
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