Diabetic neuropathy

Abstract

Diabetic neuropathy is a common and debilitating complication of diabetes mellitus associated with high health costs. The major pathogenetic hypotheses that have been invoked in diabetic neuropathy include activation of the polyol pathway, increased nonenzymatic glycation, vascular dysfunction, perturbed lipid metabolism and impaired neurotrophism. New neurotrophins and other growth factors or inflammatory mediators that influence neurons and axons have been recently identified. The diagnosis of diabetic neuropathy by neurologic history and examination, supplemented by neurophysiologic and quantitative sensory testing, is efficient and reliable. The increasing availability of additional putative treatments for diabetic neuropathy, such as islet or whole pancreas transplantation, aldose reductase inhibitors, myoinositol and trophic substances accentuates the need to search for additional means to demonstrate patient benefit related to treatment.