Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

Abstract

■ AbstractDistal symmetric sensorimotor polyneuropathy (DSPN) is the most common neurological manifestation in diabetes. Major risk factors of DSPN include diabetes duration, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. Height, smoking, insulin resistance, hypoinsulinemia, and others represent an additional risk. Importantly, hyperglycemia, hypertension, dyslipidemia, obesity, and smoking are modifiable. Stringent glycemic control has been shown to be effective in type 1, but not to the same extent in type 2 diabetes. Antilipidemic treatment, especially with fenofibrate, and multi-factorial intervention have produced encouraging results, but more experience is necessary. The major comorbidities of DSPN are depression, autonomic neuropathy, peripheral artery disease, cardiovascular disease, nephropathy, retinopathy, and medial arterial calcification. Knowledge of risk factors and comorbidities has the potential to enrich the therapeutic strategy in clinical practice as part of the overall medical care for patients with neuropathy. This article provides an updated overview of DSPN risk factors and comorbidities.

Why Not to Use the Handgrip Test in the Assessment of Cardiovascular Autonomic Neuropathy Among Patients with Diabetes Mellitus?

“…The majority of patients with DM, especially those with autonomic neuropathy, have hypertension as well [30,32,36,46,47]. Most patients with DM and hypertension are treated with ACE inhibitors, while these drugs might have an effect on autonomic function as well.…”

Arterial Calcification in Diabetes Mellitus

“…Of note, neuropathy is emerging as once key contributor to arterial calcification in humans 58 . Indeed, when neurectomy had been utilized in the past to address intractable ischemia rest pain in individuals afflicted with peripheral arterial disease (PAD), profound ipsilateral medial artery calcification blossoms in those so treated 59 .…”

NC-stat for the diagnosis of diabetic polyneuropathy

“…Diabetic polyneuropathy (DPN) is the most common chronic complication of diabetes mellitus (DM) [1], affecting approximately 20% of community patients [2], whereas it is increasingly appreciated that it is also present in a substantial percentage of patients with prediabetes [3]. It is predictably associated with significant comorbidities including lower leg amputation, depression, and cardiovascular disease [2].…”

“…It is predictably associated with significant comorbidities including lower leg amputation, depression, and cardiovascular disease [2]. However, despite a majority of diagnostic tools [1], underdiagnosis of DPN remains a serious concern, especially in the primary care setting [4].…”