Diabetic Polyneuropathy

BASICS

DESCRIPTION

Peripheral nerve dysfunction seen in diabetes; several patterns described:

  • Symmetric polyneuropathy
    • Distal sensory or sensorimotor
  • Mononeuropathy, radiculopathy, and polyradiculopathy
    • Cranial neuropathy
    • Focal limb or truncal neuropathy
    • Radiculoplexus neuropathy (diabetic amyotrophy)
  • Acute painful small fiber neuropathy
  • Autonomic neuropathies
  • Chronic inflammatory demyelinating polyneuropathy (CIDP)

EPIDEMIOLOGY

Prevalence

  • Generalized polyneuropathy
    • 10–30% at diabetes diagnosis
    • In diabetes, 50% at 10 years
    • Prevalence is higher in type 2 diabetes than type 1 diabetes.
  • Autonomic neuropathy: 16.7% in a United Kingdom study

ETIOLOGY AND PATHOPHYSIOLOGY

  • Metabolic derangement due to hyperglycemia and dyslipidemia
    • Aldose reductase converts excess glucose to sorbitol, which causes nerve damage.
    • Nonenzymatic glycation of neural proteins and lipids forms damaging advanced glycosylation end products.
    • Protein kinase C activation causes vascular endothelial changes.
    • Oxidative stress from excessive production of reactive oxygen species
    • Mitochondrial dysfunction and impaired mitochondrial trafficking within the neurons
  • Vasculopathy causing nerve ischemia: predominant factor in mononeuropathies

RISK FACTORS

  • Poor glycemic control
  • Duration of diabetes
  • Hypertension
  • Dyslipidemia
  • Obesity
  • Tobacco and alcohol consumption

GENERAL PREVENTION

  • Maintenance of normal blood sugar
  • Exercise and appropriate diet

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