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Diabetic Polyneuropathy

Diabetic Polyneuropathy is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

Peripheral nerve dysfunction seen in diabetes; several patterns described (1):

  • 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% at diabetes diagnosis
    • 50% at 10 years
    • Cross-sectional prevalence: 15% by symptoms; 50% by nerve conduction
  • Autonomic neuropathy: 16.7% in a United Kingdom study

Etiology and Pathophysiology

  • Metabolic derangement due to hyperglycemia
    • 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
    • Cyclooxygenase-2 and poly (ADP-ribose) polymerase activation
  • Vasculopathy causing nerve ischemia: predominant factor in mononeuropathies

Risk Factors

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

General Prevention

  • Maintenance of normal blood sugar
  • Exercise and appropriate diet

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Citation

Stephens, Mark B., et al., editors. "Diabetic Polyneuropathy." 5-Minute Clinical Consult, 27th ed., Wolters Kluwer, 2019. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy.
Diabetic Polyneuropathy. In: Stephens MB, Golding J, Baldor RA, et al, eds. 5-Minute Clinical Consult. 27th ed. Wolters Kluwer; 2019. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy. Accessed April 26, 2019.
Diabetic Polyneuropathy. (2019). In Stephens, M. B., Golding, J., Baldor, R. A., & Domino, F. J. (Eds.), 5-Minute Clinical Consult. Available from https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy
Diabetic Polyneuropathy [Internet]. In: Stephens MB, Golding J, Baldor RA, Domino FJ, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2019. [cited 2019 April 26]. Available from: https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Diabetic Polyneuropathy ID - 116183 ED - Stephens,Mark B, ED - Golding,Jeremy, ED - Baldor,Robert A, ED - Domino,Frank J, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -