Not all neuropathy in diabetes is of diabetic etiology: Differential diagnosis of diabetic neuropathy

Abstract

Diabetic peripheral neuropathy is the most common peripheral neuropathy in the developed world; however, not all patients with diabetes and peripheral nerve disease have a peripheral neuropathy caused by diabetes. Several (although not all) studies have drawn attention to the presence of other potential causes of a neuropathy in individuals with diabetes; 10% to 50% of individuals with diabetes may have an additional potential cause of a peripheral neuropathy and some may have more than one cause. Neurotoxic medications, alcohol abuse, vitamin B(12) deficiency, renal disease, chronic inflammatory demyelinating neuropathy, inherited neuropathy, and vasculitis are the most common additional potential causes of a peripheral neuropathy in these series. The most common disorders in the differential diagnosis of a generalized diabetic peripheral neuropathy are discussed in this article. Prospective studies to investigate the prevalence of other disorders that might be responsible for a peripheral neuropathy in individuals with diabetes are warranted.

9. Microvascular Complications and Foot Care

“…In patients with severe or atypical neuropathy, causes other than diabetes should always be considered, such as neurotoxic medications, heavy metal poisoning, alcohol abuse, vitamin B 12 deficiency (66), renal disease, chronic inflammatory demyelinating neuropathy, inherited neuropathies, and vasculitis (67).…”

Increased electrical nerve stimulation threshold of the sciatic nerve in patients with diabetic foot gangrene

“…34 Additional factors may contribute to neuropathy in diabetic patients, such as renal disease or chronic inflammatory processes. 35 Furthermore, neuropathy is associated with muscular atrophy, 36 which might further alter the motor response to nerve stimulation.…”

10. Microvascular Complications and Foot Care: Standards of Medical Care in Diabetes—2018

“…In all patients with diabetes and DPN, causes of neuropathy other than diabetes should be considered, including toxins (alcohol), neurotoxic medications (chemotherapy), vitamin B12 deficiency, hypothyroidism, renal disease, malignancies (multiple myeloma, bronchogenic carcinoma), infections (HIV), chronic inflammatory demyelinating neuropathy, inherited neuropathies, and vasculitis (100). See American Diabetes Association position statement "Diabetic Neuropathy" for more details (99 Near-normal glycemic control, implemented early in the course of diabetes, has been shown to effectively delay or prevent the development of DPN and CAN in patients with type 1 diabetes (104)(105)(106)(107).…”