Diabetic polyneuropathy

Abstract

Diabetic neuropathy is a common complication of diabetes and a cause of considerable morbidity and increased mortality. Diabetic neuropathy is not a single entity but encompasses several neuropathic syndrome. However, by far, the commonest presentation of neuropathy in diabetes is chronic distal symmetrical polyneuropathy also commonly known as diabetic peripheral neuropathy (DPN). The Toronto Diabetic Neuropathy Consensus Panel defined DPN as "a symmetrical, length-dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure and cardiovascular risk covariates. An abnormality of nerve conduction (NC) tests, which is frequently subclinical, appears to be the first objective quantitative indication of the condition. The occurrences of diabetic retinopathy and nephropathy in a given patient strengthen the case that the polyneuropathy is attributable to diabetes". This chapter covers all the neuropathic syndromes encountered in diabetes mellitus, although the main focuses are (1) DPN, which is the main initiating factor for foot ulceration and a cause of troublesome chronic painful neuropathic symptoms, and (2) autonomic neuropathy, often associated with DPN that can involve almost all the systems of the body and may have devastating consequences, such as sudden death.