Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy

Iqbal, Zohaib; Azmi, Shazli; Yadav, Rahul; Ferdousi, Maryam; Kumar, Mandhir; Cuthbertson, Daniel J.; Lim, Jonathan; Malik, Rayaz A.; Alam, Uazman

doi:10.1016/j.clinthera.2018.04.001

Cited by 356 publications

(299 citation statements)

References 180 publications

(151 reference statements)

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“…Symptoms may be vague, described as a tight feeling or abnormal sensation in the soles of the feet, intolerance of tactile stimuli (inability to wear socks or touch bedsheets), or a sensation of restless legs. The distribution of symptoms may have a length dependent or non-length dependent pattern that affects the limbs, trunk, face, or it may have a combination of patterns 12404142. Depending on the underlying cause, the onset of symptoms may be gradual, with slowly progressive worsening, or subacute with more rapid progression.…”

Section: Clinical Presentationmentioning

confidence: 99%

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Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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Sensory polyneuropathies, which are caused by dysfunction of peripheral sensory nerve fibers, are a heterogeneous group of disorders that range from the common diabetic neuropathy to the rare sensory neuronopathies. The presenting symptoms, acuity, time course, severity, and subsequent morbidity vary and depend on the type of fiber that is affected and the underlying cause. Damage to small thinly myelinated and unmyelinated nerve fibers results in neuropathic pain, whereas damage to large myelinated sensory afferents results in proprioceptive deficits and ataxia. The causes of these disorders are diverse and include metabolic, toxic, infectious, inflammatory, autoimmune, and genetic conditions. Idiopathic sensory polyneuropathies are common although they should be considered a diagnosis of exclusion. The diagnostic evaluation involves electrophysiologic testing including nerve conduction studies, histopathologic analysis of nerve tissue, serum studies, and sometimes autonomic testing and cerebrospinal fluid analysis. The treatment of these diseases depends on the underlying cause and may include immunotherapy, mitigation of risk factors, symptomatic treatment, and gene therapy, such as the recently developed RNA interference and antisense oligonucleotide therapies for transthyretin familial amyloid polyneuropathy. Many of these disorders have no directed treatment, in which case management remains symptomatic and supportive. More research is needed into the underlying pathophysiology of nerve damage in these polyneuropathies to guide advances in treatment.

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Section: Clinical Presentationmentioning

confidence: 99%

“…42154 Most neuromuscular experts advocate for the use of electrodiagnostic studies in distal symmetric polyneuropathy if the diagnosis is known or unknown 155. Several studies have shown that electrodiagnostic studies in this population can often change the diagnosis and management 156157158.…”

Section: Diagnostic Approachmentioning

confidence: 99%

Diagnosis and management of sensory polyneuropathy

Gwathmey

Pearson

2019

BMJ

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“…18 In this month's Topic Update, Dr. Zohaib Iqbal, Institute of Aging and Chronic Disease, University Hospital Aintree, University of Liverpool (Liverpool, United Kingdom), provides a critical review of current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. 19 Appropriate control of blood glucose and the management of the risk factors for cardiovascular disease substantially reduce the risk for microvascular and macrovascular complications among people with type 1 diabetes. 20 Diabetes control among patients with type 1 diabetes has been shown to improve with continuous subcutaneous insulin infusion (CSII), delivered via an insulin pump, 21 and a significant body of evidence accumulated over the past 25 years supports the efficacy of subcutaneous insulin delivered via a pump.…”

Section: Emerging Diabetes Research From Early Investigatorsmentioning

confidence: 99%

Emerging Diabetes Research From Early Investigators

Ryan

2018

Clinical Therapeutics

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“…So when I talk of negative sensory symptoms this includes the feeling of deadness and numbness, feeling that a person is wearing gloves and stockings. Positive symptoms are ones that tend to trouble the patients certainly a lot more; these include electric shock-like feelings, aching, tightness, hypersensitivity to touch, burning and prickling and all of these can cause a considerable amount of pain and discomfort [4].…”

mentioning

confidence: 99%

“…[For further review and for further reading, Dr Alam would suggest a paper which he published in Clinical Therapeutics 2018 by the name of ''Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy'' [4]. This a detailed paper looking at the epidemiology and has detailed sections on pharmacotherapy.…”

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confidence: 99%