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