Diabetic Neuropathy – Nerve Morphology in the Upper Extremity

Abstract

Diabetic neuropathy is the most common long-term complication of Type 1 and Type 2 diabetes, affecting approximately 10% within a year of diagnosis to 50% of subjects with diabetes for more than 25 years. Prevalence rates depend on diagnostic technique and the population under study (Dahlin et al., 2011; Rubino et al., 2007). Diabetic neuropathy associated with Type 1 diabetes tend to be more frequent, and develop more rapidly than in Type 2 diabetes. Gender differences seem to exist with males being more affected by neuropathy than females (Booya et al., 2005; Aaberg et al., 2008). Diabetes mellitus imposes a considerable burden on the nervous system and is the most common cause of peripheral nerve damage associated with a vast spectrum of neuropathy syndromes. The primary risk factor for the development of diabetic neuropathy is related to duration and severity of hyperglycaemia. Other independent risk factors for diabetic neuropathy include hypertension, hypercholesterolemia, smoking, increased body mass index and the presence of other complications of diabetes such as retinopathy and nephropathy (Adler et al., 1997). Diabetic neuropathy affects somatic as well as autonomic neurons of the peripheral nervous system with resultant morbidity and mortality for the patients and economic cost for the society and health care system. Interactions of pathogenic metabolic and vascular factors are responsible for the development of diabetic neuropathy. These complex mechanisms, which are not fully understood, need further clarification in order to develop new treatment strategies. The aim of this chapter is to describe methods and result in the evaluation of small and large nerve fibre pathology on the upper extremity.