Diabetic neuropathy: classification, measurement and treatment

Area of Science:

• Neurology
• Endocrinology
• Diabetology

Background:

• Diabetic neuropathies are common long-term complications of diabetes, affecting somatic and autonomic nerves.
• This review focuses on recent advancements in understanding and managing these conditions.

Purpose of the Study:

• To review updated classifications of diabetic neuropathies.
• To discuss noninvasive assessment methods for somatic neuropathy.
• To explore new management strategies for painful neuropathic symptoms.

Main Methods:

• Review of recent literature on diabetic neuropathy classification and assessment.
• Evaluation of minimally invasive skin biopsies and corneal confocal microscopy for diagnosis.
• Analysis of evidence-based therapies for neuropathic pain.

Main Results:

• Diabetic neuropathy classification should incorporate 'prediabetic neuropathy' or 'neuropathy of impaired glucose tolerance'.
• Skin biopsies and corneal confocal microscopy show promise for evaluating small fiber neuropathies.
• Evidence-based therapies are available for managing painful neuropathic symptoms.

Conclusions:

• Patients with idiopathic neuropathy should be screened for impaired glucose tolerance and considered for lifestyle changes.
• Future research requires more relevant surrogate endpoints for therapy trials.
• Prescribing for painful neuropathy should prioritize therapies validated by independent randomized controlled trials.