Diabetic neuropathy

Abstract

Diabetic neuropathy (DN) is one of the most common complications related to diabetes. While any nerve in the body may be affected, the length dependent distal symmetrical sensory predominant neuropathy (DSPN) is the most classical presentation. DSPN develops insidiously and often remains asymptomatic until well established. Important complications of DSPN include the development of neuropathic pain, foot deformities and ulceration all which lead to considerable morbidity and which may put the patient on a pathway to lower extremity amputation. Impairment of autonomic control may lead to various presentations from the organ systems involved such as cardiovascular, gastrointestinal, genitourinary and sudomotor neuropathies. Although hyperglycaemia related neuronal damage has been long considered the key aetiopathogenic trigger, more recently other factors, such as cardiometabolic and vascular risk factors, are increasingly recognised to play a significant role in DN development. Newer putative agents, although have shown promise in experimental diabetic neuropathy, are yet to be proven clinically. Thus, glucose control remains the only proven strategy to delay the development of DN. Treatment of neuropathic pain, an annual foot risk assessment and ulcer prevention strategies along with symptomatic management of autonomic features and optimisation of cardiovascular risk factors are important management considerations. In this review, we discuss the classification, diagnosis and management of the DN with a focus on DSPN.