Small Fiber Neuropathy in Diabetes: Clinical Consequence and Assessment

Abstract

Recent findings have shed new light on the role of peripheral nerves in the skin and have established a modern concept of cutaneous neurobiology. There is bidirectional rather than unidirectional (conveying information from the periphery) signaling between central and peripheral nerves and the endocrine and immune systems. This interaction is mediated principally by cutaneous small nerve fibers and will influence a variety of physiologic and pathophysiologic functions central to wound healing, which include cellular development, growth, differentiation, immunity, vasoregulation, and leukocyte recruitment. Thus, disease of the small fibers in diabetic patients is frequent and may have a considerable impact on the predisposition and subsequent wound-healing response to foot ulceration. The authors review the basic pathophysiology, clinical consequences, and current methods to evaluate somatic and autonomic nerve fiber dysfunction and damage.

Effect of Intensive Nursing Education on the Prevention of Diabetic Foot Ulceration Among Patients with High-Risk Diabetic Foot: A Follow-Up Analysis

“…All these mechanisms raise the risk of foot skin damage and promote ulcer formation without any sensation. [22][23][24] In our study, we took all these aspects into consideration in the intensive nursing education. Once callosity was found, assistant management of callus was applied in time.…”

Remote neurotrophic support of epidermal nerve fibres in experimental diabetes

“…In patients with small fibre neuropathy due to diabetes, nerve conduction studies can be normal, and the use of an epidermal punch biopsy may be necessary to identify early distal loss of epidermal axons [38,39]. Both diabetes and impaired glucose tolerance are associated with a decreased ENFD in humans [16,40].…”

Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections

“…Substance P and nerve growth factor promote immune cell chemotaxis and proliferation, and decreased production of these neuropeptides in patients with diabetic neuropathy can slow wound healing [9]. In addition, leucocyte migration may be impaired in denervated tissues [9,10]. Movement of immune cells and nutrients to the site of infection may be further impaired in patients with PVD as the result of prolonged inflammation resulting in thickening of capillary basement membranes [9].…”