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Vinik, Aaron; Casellini, Carolina; Nevoret, Marie-Laure, et al.
. Date of publication 2015 Jan 1;volume ():.
Diabetic neuropathy (DN) is the most common form of neuropathy in developed countries and may affect about half of all patients with diabetes (DM), contributing to substantial morbidity and mortality and resulting in a huge economic burden. DN encompasses multiple different disorders involving proximal, distal, somatic, and autonomic nerves. It may be acute and self-limiting or a chronic, indolent condition. DN may be silent and go undetected while exercising its ravages, or it may present with clinical symptoms and signs that may mimic those seen in many other diseases. The proper diagnosis therefore requires a thorough history, clinical and neurological examinations, and exclusion of secondary causes. The distal neuropathies are characteristically symmetric, glove and stocking distribution, length-dependent sensorimotor polyneuropathies that develop on a background of long-standing chronic hyperglycemia superimposed upon cardiovascular risk factors. Diagnosis is based on a combination of signs, symptoms, and abnormal neurophysiological test results. No treatment has been approved for the prevention or reversal of DN. Even tight glycemic control at best limits the progression of neuropathy in patients with type 1 DM, but does not affect DN in patients with type 2 DM. It has been estimated that between 3 and 25% of persons with DM might experience neuropathic pain. Painful DN can be difficult to treat, and is associated with reduced quality of life, poor sleep, depression and anxiety. Treatment guidelines suggest that pregabalin, gabapentin, venlafaxine, duloxetine, tricyclic antidepressants, and opioids are the drugs with the best evidence to support their use for painful DN. Tapentadol has also received FDA approval for the treatment of painful DN. The reported prevalence of diabetic autonomic neuropathy (DAN) varies widely (7.7 to 90%) depending on the cohort studied and the methods used for diagnosis, and can affect any organ system. Cardiovascular autonomic neuropathy (CAN) is significantly associated with overall mortality and with morbidity, including silent myocardial ischemia, coronary artery disease, stroke, DN progression, and perioperative complications. Cardiovascular reflex tests are the criterion standard in clinical autonomic testing; combining these with sudomotor function tests may allow a more accurate diagnosis. Strict glycemic control, management of lipids and blood pressure as well as the use of antioxidants. and ACE inhibitors reduce the odds ratio for DAN to 0.32; treatment is otherwise symptomatic. For complete coverage of this and related areas in Endocrinology, visit the free online web-textbook, www.endotext.org. Copyright © 2000-2017, MDText.com, Inc.
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Diabetic Foot Ulcer - Introduction and Assessment