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This document summarizes the clinical management of diabetic neuropathy. It discusses the types and classification of diabetic neuropathy, signs and symptoms, diagnosis, incidence and risk factors. It also reviews the evidence for preventing neuropathy through tight glycemic control from studies like the DCCT trial. Finally, it discusses medications used to treat painful diabetic neuropathy, including tricyclic antidepressants, gabapentin, and SSRIs based on clinical trials.

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Diabetic Neuropathy: An approach to the clinical management William L. Watkins, MD Internal Medicine Resident Grand Rounds February 16, 1999
Case Presentation ,[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object],[object Object],[object Object]
Case Presentation ,[object Object],[object Object]
Objectives ,[object Object],[object Object],[object Object],[object Object]
Diabetic Neuropathy ,[object Object],[object Object],[object Object]
Definition according to the San Antonio Conference on Diabetic Neuropathy 1988 ,[object Object]
Classification of Diabetic Neuropathy ,[object Object],[object Object],[object Object]
Classification of Diabetic Neuropathy ,[object Object],[object Object],[object Object],[object Object],[object Object]
Classification of Diabetic Neuropathy ,[object Object]
Signs and symptoms of Peripheral Sensorimotor Polyneuropathy ,[object Object],[object Object],[object Object],[object Object]
Physical Exam Clues to the Diagnosis ,[object Object],[object Object],[object Object],[object Object]
 
 
Electrophysiologic Studies ,[object Object],[object Object],[object Object],[object Object]
Differential Diagnosis ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pathophysiology ,[object Object],[object Object],[object Object]
Incidence ,[object Object],[object Object],[object Object],[object Object]
Incidence (Partanen,NEJM 1995) ,[object Object],[object Object],[object Object],[object Object]
Incidence (Partanen,NEJM 1995) ,[object Object],[object Object],[object Object]
 
 
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention The Diabetes Control and Complications Trial NEJM 1993 ,[object Object],[object Object],[object Object],[object Object]
Prevention The Diabetes Control and Complications Trial NEJM 1993 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention The Diabetes Control and Complications Trial NEJM 1993 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Prevention The Diabetes Control and Complications Trial NEJM 1993 ,[object Object],[object Object],[object Object],[object Object]
DCCT
Prevention Kumamoto Study Diabetes Research and Clinical Practice 1995 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management of Neuropathic Pain ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tricyclic Antidepressants ,[object Object],[object Object]
Tricyclic Antidepressants Max etal. Neurology. 1987 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tricyclic Antidepressants Max etal. Neurology. 1987 ,[object Object],[object Object],[object Object],[object Object]
Meta-Analysis of Antidepressants McQuay et al. Pain. 1996 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Meta-Analysis of Antidepressants McQuay et al. Pain. 1996 ,[object Object],[object Object],[object Object],[object Object],[object Object]
SSRIs Sindrup et al. Pain. 1990 ,[object Object],[object Object],[object Object],[object Object],[object Object]
SSRIs Sindrup et al. Pain. 1990 ,[object Object],[object Object],[object Object]
SSRIs Sindrup et al. Pain. 1990 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SSRIs Sindrup et al. Pain. 1990 ,[object Object],[object Object],[object Object]
SSRIs and Tricyclics Max et al. NEJM 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object]
SSRIs and Tricyclics Max et al. NEJM 1992 ,[object Object],[object Object]
SSRIs and Tricyclics Max et al. NEJM 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
SSRIs and Tricyclics Max et al. NEJM 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Anticonvulsants McQuay et al. BMJ. 1995 ,[object Object],[object Object],[object Object],[object Object]
Gabapentin (Neurontin) Backonja et al. JAMA. 1998 (ParkeDavis) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gabapentin Backonja et al. JAMA. 1998 (ParkeDavis) ,[object Object],[object Object],[object Object],[object Object],[object Object]
Gabapentin Backonja et al. JAMA. 1998 (ParkeDavis) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Gabapentin Backonja et al. JAMA. 1998 (ParkeDavis) ,[object Object],[object Object],[object Object]
Gabapentin Backonja et al. JAMA. 1998 (ParkeDavis) ,[object Object],[object Object],[object Object],[object Object]
Mexilitine Stracke et al. Diabetes Care 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mexilitine Stracke et al. Diabetes Care 1992 ,[object Object],[object Object],[object Object]
Mexilitine Stracke et al. Diabetes Care 1992 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Mexilitine Stracke et al. Diabetes Care 1992 ,[object Object],[object Object]
Mexilitine Oskarsson et al. Diabetes Care 1997 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tramadol (Ultram) Harati et al. Neurology 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object]
Tramadol (Ultram) Harati et al. Neurology 1998 ,[object Object],[object Object],[object Object],[object Object]
Tramadol (Ultram) Harati et al. Neurology 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tramadol (Ultram) Harati et al. Neurology 1998 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Tramadol (Ultram) Harati et al. Neurology 1998 ,[object Object],[object Object],[object Object]
Capsaicin Donofrio et al. Archives of Int Med 1991 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Capsaicin Donofrio et al. Archives of Int Med 1991 ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Capsaicin Donofrio et al. Archives of Int Med 1991 ,[object Object],[object Object],[object Object]
Capsaicin Donofrio et al. Archives of Int Med 1991 ,[object Object]
Capsaicin Donofrio et al. Archives of Int Med 1991 ,[object Object],[object Object],[object Object]
Alternative Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object]
Alternative Therapies ,[object Object],[object Object],[object Object]
Possible Future Therapies ,[object Object],[object Object],[object Object]
Possible Future Therapies ,[object Object],[object Object],[object Object],[object Object]
Possible Future Therapies ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention of Foot Complications ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Prevention of Foot Complications ,[object Object],[object Object],[object Object],[object Object]
Prevention of Foot Complications ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
 

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  • 1. Diabetic Neuropathy: An approach to the clinical management William L. Watkins, MD Internal Medicine Resident Grand Rounds February 16, 1999
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