Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity

Abstract

Prior to a joint meeting of the Neurodiab Association and International Symposium on Diabetic Neuropathy held in Toronto, Ontario, Canada, 13-18 October 2009, Solomon Tesfaye, Sheffield, UK, convened a panel of neuromuscular experts to provide an update on polyneuropathies associated with diabetes (Toronto Consensus Panels on DPNs, 2009). Herein, we provide definitions of typical and atypical diabetic polyneuropathies (DPNs), diagnostic criteria, and approaches to diagnose sensorimotor polyneuropathy as well as to estimate severity. Diabetic sensorimotor polyneuropathy (DSPN), or typical DPN, usually develops on long-standing hyperglycaemia, consequent metabolic derangements and microvessel alterations. It is frequently associated with microvessel retinal and kidney disease-but other causes must be excluded. By contrast, atypical DPNs are intercurrent painful and autonomic small-fibre polyneuropathies. Recognizing that there is a need to detect and estimate severity of DSPN validly and reproducibly, we define subclinical DSPN using nerve conduction criteria and define possible, probable, and confirmed clinical levels of DSPN. For conduct of epidemiologic surveys and randomized controlled trials, it is necessary to pre-specify which attributes of nerve conduction are to be used, the criterion for diagnosis, reference values, correction for applicable variables, and the specific criterion for DSPN. Herein, we provide the performance characteristics of several criteria for the diagnosis of sensorimotor polyneuropathy in healthy subject- and diabetic subject cohorts. Also outlined here are staged and continuous approaches to estimate severity of DSPN.

Ankle-brachial index and diabetic neuropathy: study of 225 patients

“…Diagnosis becomes difficult when peripheral arterial disease is associated with peripheral diabetic neuropathy, since the latter could mask claudication and pain at rest induced by severe ischemia, with the consequent prevalence of neuropathic pain diagnoses. It is also known that only one third of patients with diabetes present with intermittent claudication 24 . However, the sensitivity of this ABI threshold (0.9-1.3) seems to be lower in complicated type 2 diabetes, particularly in the presence of peripheral diabetic neuropathy; 13.6% of patients with type 2 diabetes present with peripheral arterial disease compared to 4% in the general population 15 .…”

Impaired Awareness of Hypoglycemia in Adults With Type 1 Diabetes Is Not Associated With Autonomic Dysfunction or Peripheral Neuropathy

“…Participants were also classified using the staged approach for estimating neuropathy severity as suggested by the Toronto Consensus Panel on Diabetic Neuropathy (30).…”

Proposta De Um Sistema Para Estudos De Condução Nervosa

“…A PDP é a complicação mais comum da diabetes mellitus e pode envolver vários nervos tanto sensoriais (e.g., sural, ulnar e peroneal) quanto motores (e.g., tibial, peroneal, ulnar, entre outros). O ECN é uma indicação objetiva e quantitativa desta condição sendo essencial para o seu diagnóstico confirmativo [5]. Na STC ocorre a compressão do nervo mediano, e nesse caso o ECN pode avaliar as alterações do PA e da velocidade de condução e assim indicar a gravidade da condição [6].…”