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[Diabetic neuropathy: vascular disease?].

E Otero-Siliceo1, L A Ruano-Calderón

  • 1Neurología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, México DF, México. dr_enriqueotero@yahoo.com

Revista De Neurologia
|October 29, 2003
PubMed
Summary

Diabetic neuropathy, a major complication, involves nerve damage. Both microvascular changes and metabolic pathways due to hyperglycemia contribute to its development.

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Medical hypotheses·2003

Area of Science:

  • Neurology
  • Endocrinology
  • Diabetology

Background:

  • Diabetes mellitus presents significant neurologic complications.
  • These include neuropathy (peripheral and autonomic), retinopathy, and cerebrovascular disease.
  • Neuropathy primarily affects lower limbs, while microvascular disease impacts the retina, and macrovascular disease leads to stroke.

Purpose of the Study:

  • To review the evolving understanding of diabetic neuropathy.
  • To explore the pathogenetic theories of diabetic neuropathy.
  • To elucidate the relationship between microangiopathy and metabolic changes in diabetes.

Main Methods:

  • Literature review of diabetic neuropathy definitions and theories over 50 years.
  • Analysis of pathogenetic theories including polyol pathway, microvascular, and glycosylation end product theories.
  • Examination of the role of small vessel disease in diabetic peripheral neuropathy.

Main Results:

  • Diabetic neuropathy definitions have evolved significantly.
  • Multiple pathophysiologic factors likely contribute to diabetic neuropathy simultaneously.
  • Small vessel disease, not large vessel disease, appears to play a role in diabetic peripheral neuropathy.

Conclusions:

  • Microangiopathy and metabolic pathway alterations in diabetes are closely interconnected.
  • A single theory may be insufficient to explain the complex manifestations of diabetic neuropathy.
  • Hyperglycemia-induced metabolic changes and microangiopathy share a stronger relationship than previously recognized.

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