Diabetic Neuropathies

Abstract

Diabetes is the most common cause of peripheral neuropathy in the world. Both type 1 (insulin‐dependent) and type 2 diabetes are commonly complicated by peripheral nerve disorders. Two main types of neuropathy are observed: the most common is a nerve fibre length dependent, distal symmetrical sensory polyneuropathy with little motor involvement but frequent, and potentially life threatening, autonomic dysfunction. Alteration of temperature and pain sensations in the feet is an early manifestation of diabetic polyneuropathy. The second pattern is a focal neuropathy which more commonly complicates or reveal type 2 diabetes. Poor diabetic control increases the risk of neuropathy with subsequent neuropathic pains and trophic changes in the feet, which can be prevented by patient's education.

Key Concepts:

  • Length‐dependent diabetic polyneuropathy is the most common neuropathy in the world.

  • Neuropathic pains are the most common symptoms of diabetic neuropathy.

  • Charcot joints and plantar ulcers are favored by loss of pain sensation.

  • Autonomic dysfunction is commonly associated with small fibre diabetic neuropathy.

  • The prevalence of diabetic polyneuropathy increases with duration and poor diabetic control.

  • Focal neuropathies are more common in type 2 diabetic patient.

Keywords: diabetic neuropathy; small fibre neuropathy; neuropathic pain; autonomic dysfunction; proximal diabetic neuropathy; oculomotor palsy; nerve biopsy

Figure 1.

Proximal diabetic neuropathy Diabetic patient with severe, bilateral proximal neuropathy with massive atrophy of quadriceps muscles.

Figure 2.

Sural nerve biopsy from a patient with a severe sensory diabetic polyneuropathy and osteoarthropathy. This one micron thick plastic cross section shows a severe reduction of the density of myelinated fibres, with nearly total disappearance of smaller myelinated fibres, with the exception of the cluster of small regenerating fibres (long arrow). Note the axon‐myelin debris characteristic of axonal degeneration (short arrows). Thionine staining. Bar: 20 μm.

Figure 3.

Proximal diabetic neuropathy: Biopsy specimen of the intermediate cutaneous nerve of the thigh. Cross section of a paraffin embedded biopsy specimen of the intermediate cutaneous nerve of the thigh from a patient with proximal diabetic neuropathy, to show massive inflammatory infiltrate by mononuclear cells of the perineurium and neighbouring endoneurial blood vessels. H & E staining. Bar: 50 μm.

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Further reading

Reasner CA (2008) Reducing cardiovascular complications of type 2 diabetes by targeting multiple risk factors. Journal of Cardiovascular Pharmacology 52(2): 136–144.

Vincent AM and Feldman EL (2004) New insights into the mechanisms of diabetic neuropathy. Reviews in Endocrine & Metabolic Disorders 5(3): 227–236.

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Said, Gérard(Jul 2012) Diabetic Neuropathies. In: eLS. John Wiley & Sons Ltd, Chichester. http://www.els.net [doi: 10.1002/9780470015902.a0024020]