02 November 2004
Peripheral neuropathy is a major late complication of diabetes mellitus. The pathogenesis is multifactorial. Changes in polyol pathway flux, oxidative stress, non-enzymatic protein glycation, endothelial dysfunction leading to reduced nerve blood flow, disturbed calcium homeostasis and deficits in neurotrophic factors probably all contribute to the clinical and neurophysiological findings in the diabetic patient with neuropathy. The relative contribution of each of these factors in the development of neuropathy may vary in individual patients. Possibly this is one of the explanations for the marked heterogeneity of the clinical picture of diabetic neuropathy.
A.C. Kappelle, M.D., Ph.D.
I.N. van Schaik, M.D., Ph.D.
Diabetic neuropathy is a heterogeneous disorder. Between patients, marked differences can be observed in the pattern of distribution of affected nerves (e.g. distal symmetrical versus focal neuropathy), as well as in the types of nerve fibres involved (e.g. small versus Read more
Of the various patterns of neuropathy, distal symmetric sensorimotor polyneuropathy is the most common, giving rise to symptoms in approximately 10 to 15% of diabetic patients (Dyck et al 1993; Ross 1993). The asymptomatic form is about two to three times as prevalent as the symptomatic form (Dyck et al 1993).
According to the “guideline neuropathy” that was prepared by the Dutch society of Neurology and Neurophysiology and supported by Institute for Healthcare Improvement (CBO) in 2003, additional (neurophsyiological) tests are not indicated in those patients with diabetes and symptoms and signs that are compatible with a distal symmetrical sensory motor neuropathy.
The onset and progression of peripheral neuropathy can be effectively delayed by maintaining strict glycaemic control The diabetes control and complication study group 1993). Still, in some patients neuropathy develops despite efforts to control glycaemia. Therefore, specific pharmacotherapy aimed to protect the nerve against the adverse effects of diabetes is in demand. Read more
For references see the CBO
website (richtlijn Polyneuropathie)