Diabetic Neuropathies

Abstract

Diabetes is the most common cause of peripheral neuropathy in the world. Both type 1 (insulin‐dependent) and type 2 diabetes are commonly complicated by peripheral nerve disorders. Two main types of neuropathy are observed: the most common is a nerve fibre length dependent, distal symmetrical sensory polyneuropathy with little motor involvement but frequent, and potentially life threatening, autonomic dysfunction. Alteration of temperature and pain sensations in the feet is an early manifestation of diabetic polyneuropathy. The second pattern is a focal neuropathy which more commonly complicates or reveal type 2 diabetes. Poor diabetic control increases the risk of neuropathy with subsequent neuropathic pains and trophic changes in the feet, which can be prevented by patient's education. Key Concepts: Length‐dependent diabetic polyneuropathy is the most common neuropathy in the world. Neuropathic pains are the most common symptoms of diabetic neuropathy. Charcot joints and plantar ulcers are favored by loss of pain sensation. Autonomic dysfunction is commonly associated with small fibre diabetic neuropathy. The prevalence of diabetic polyneuropathy increases with duration and poor diabetic control. Focal neuropathies are more common in type 2 diabetic patient.