SUMMARYDiabetic peripheral neuropathy (DPN) affects up to 50% of patients with diabetes and is a major cause of morbidity and increased mortality. Its clinical manifestations include painful neuropathic symptoms and insensitivity, which increases the risk for burns, injuries and foot ulceration. Several recent studies have implicated poor glycaemic control, duration of diabetes, hyperlipidaemia (particularly hypertryglyceridaemia), elevated albumin excretion rates and obesity as risk factors for the development of DPN. Although there is now strong evidence for the importance of nerve microvascular disease in the pathogenesis of DPN, the risk factors for painful DPN are not known. However, emerging evidence regarding the central correlates of painful DPN is now afforded by brain imaging. The diagnosis of DPN begins with a careful history of sensory and motor symptoms. The quality and severity of neuropathic pain if present should be assessed using a suitable scale. Clinical examination should include inspection of the feet and evaluation of reflexes and sensory responses to vibration, light touch, pinprick and the 10-g monofilament. Glycaemic control and addressing cardiovascular risk is now considered important in the overall management of the neuropathic patient. Pharmacological treatment of painful DPN includes tricyclic compounds, serotonin-norepinephrine reuptake inhibitors (e.g. duloxetine), anticonvulsants (e.g. pregabalin), opiates, membrane stabilizers, the antioxidant alpha lipoic acid and others. Over the past 7 years, new agents with perhaps less side effect profiles have immerged. Management of patients with painful neuropathy must be tailored to individual requirements and will depend on the presence of other co-morbidities. There is limited literature with regard to combination treatment. Copyright © 2012 John Wiley & Sons, Ltd.Keywords diabetic neuropathy; diabetic peripheral neuropathy; painful diabetic neuropathy; pathogenesis of diabetic neuropathy; MRI Diabetic peripheral neuropathy (DPN) is associated with considerable morbidity, mortality and diminished quality of life [1]. Characterized by pain, paraesthesia and sensory loss, it affects up to 50% of people with diabetes [1]. In absolute numbers, against the estimated global prevalence of diabetes of 472 million by 2030 [2], DPN is likely to affect as many as 236 million persons worldwide and at a tremendous cost. In the United States alone, the total cost associated with DPN is $10.9 billion a year [3]. Thus, from these epidemiologic data, it is clear that DPN and the associated foot ulceration and neuropathic pain are far from rare and far from benign, posing a major healthcare challenge to the medical profession and to the society.
