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The diabetic neuropathies.

Clifton Gooch1, David Podwall

  • 1Electromyography Laboratory, Columbia University College of Physicians and Surgeons, Columbia Presbyterian Medical Center, 710 West 168th Street, 13th Floor, New York, NY 10032, USA. clg33@columbia.edu

The Neurologist
|November 3, 2004
PubMed
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Diabetic neuropathy, a common complication of diabetes, is often misdiagnosed and undertreated. Early recognition and comprehensive management are crucial for reducing patient suffering and healthcare costs.

Area of Science:

  • Neurology
  • Endocrinology
  • Diabetology

Background:

  • Diabetes is the leading cause of neuropathy in the US, causing significant morbidity, mortality, and healthcare expenses.
  • Understanding diabetic neuropathy's pathophysiology has advanced, revealing multiple nerve injury mechanisms.

Purpose of the Study:

  • To review the current understanding of diabetic neuropathies.
  • To highlight the importance of accurate diagnosis and effective treatment.

Main Methods:

  • Review of recent advances in diabetes basic science.
  • Analysis of identified mechanisms of nerve injury in diabetes.
  • Examination of various clinical presentations of diabetic neuropathy.

Main Results:

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  • Multiple potential mechanisms for diabetic nerve injury identified, including polyol pathway, oxidative stress, advanced glycosylation end products, and vascular insufficiency.
  • Diabetic neuropathy presents in diverse forms beyond distal symmetric neuropathy, often leading to misdiagnosis.
  • Effective pharmacologic agents are emerging for painful diabetic neuropathy management.

Conclusions:

  • Diabetic neuropathies are prevalent but frequently misdiagnosed and inadequately treated.
  • Understanding disease mechanisms and clinical recognition are vital for effective management.
  • Appropriate primary and symptomatic treatments can significantly decrease associated morbidity and mortality.