4. Definition
โThe presence of signs and/or
symptoms of peripheral
nerve dysfunction in
diabetic patient after
exclusion of other causes.โ
6Boulton AJ, Gries FA, Jervell JA: Guidelines for the diagnosis and outpatient management of
diabetic peripheral neuropathy. Diabet Med 15:508โ514, 1998
7. Epidemiology
๏ฑ50% of patients who have
diabetes for >25 yrs (Pirart. Diabetes Care 1978)
๏ฑLate in type 1, may be 1st
presentation of type 2 DM
๏ฑ50% are painful neuropathy
14. Peripheral sensori-motor
neuropathy
๏ฌ Distal, bilateral,symmetrical, stocking-glove
distribution.
๏ฌ Symptoms range from numbness
(โdeadnessโ) to severe pain. Burning,
alteration of temperature sensation,
parathesias, shooting, or stabbing pains are
common.
๏ฌ May worsen at night.
๏ฌ Minor motor involvement causing weakness.
16. Autonomic neuropathy
๏ฌAffects the autonomic nerves controlling
internal organs
๏ถ Peripheral
๏ถ Genitourinary
๏ถ Gastrointestinal
๏ถ Cardiovascular
๏ฌIs classified as clinical or subclinical based
on the presence or absence of symptoms
17. Peripheral Autonomic Dysfunction
Contributes to the following
symptoms/signs:
๏ถNeuropathic arthropathy (Charcot foot)
๏ถAching, pulsation, tightness, cramping,
dry skin, pruritus, edema, sweating
abnormalities
๏ถWeakening of the bones in the foot
leading to fractures
24. Based on Pathogenesis
Compound Status of RCTs
alpha- lipoic acid Effective in RCTs
Vasodilators Effective in 1 trial
ACE inhibitor Effective in 1 trial
Protein kinase inhib Ongoing
NGF Ineffective
31. Diabetic neuropathy OR Neuropathy
in diabetic patient ?
๏ฌChronic
inflammatory
demyelinating
polyneuropathy
๏ฌB12 deficiency
๏ฌUremia
๏ฌHypothyroidism
๏ฌMonoclonal
gamopathies
1/3 of diabetics
have
neuropathy
unrelated to
diabetes
32. Diabetic neuropathy OR Neuropathy
in diabetic patient ?
o Rapidly progressive
o Prominent motor
o Cranial nerves
o Predominant large fiber
33. Summary
๏ฌDiabetic neuropathy is common [up to
40-50% over a 10-25 year span]
๏ฌTight control can prevent neuropathy
๏ฌOnce a patient develops neuropathy,
there are few treatments proven to be
effective
๏ฌFoot care is essential in preventing
neuropathic complications
๏ฌNeuropathy in diabetic patient may be
caused by other etiologies