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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Citation
Domino, Frank J., et al., editors. "Diabetic Polyneuropathy." 5-Minute Clinical Consult, 33rd ed., Wolters Kluwer, 2025. Medicine Central, im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy.
Diabetic Polyneuropathy. In: Domino FJF, Baldor RAR, Golding JJ, et al, eds. 5-Minute Clinical Consult. Wolters Kluwer; 2025. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy. Accessed December 12, 2024.
Diabetic Polyneuropathy. (2025). In Domino, F. J., Baldor, R. A., Golding, J., & Stephens, M. B. (Eds.), 5-Minute Clinical Consult (33rd ed.). Wolters Kluwer. https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/116183/all/Diabetic_Polyneuropathy
Diabetic Polyneuropathy [Internet]. In: Domino FJF, Baldor RAR, Golding JJ, Stephens MBM, editors. 5-Minute Clinical Consult. Wolters Kluwer; 2025. [cited 2024 December 12]. 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
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