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Diabetic neuropathy

Department of Neurology, Sanjay Gandhi PGIMS, Lucknow, India

Correspondence to:
Correspondence to:
Professor U K Misra
Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareilly Road, Lucknow 226014, India; ukmisra{at}sgpgi.ac.in

Diabetic neuropathy (DN) refers to symptoms and signs of neuropathy in a patient with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the commonest accounting for 75% DN. Asymmetrical neuropathies may involve cranial nerves, thoracic or limb nerves; are of acute onset resulting from ischaemic infarction of vasa nervosa. Asymmetric neuropathies in diabetic patients should be investigated for entrapment neuropathy. Diabetic amyotrophy, initially considered to result from metabolic changes, and later ischaemia, is now attributed to immunological changes. For diagnosis of DN, symptoms, signs, quantitative sensory testing, nerve conduction study, and autonomic testing are used; and two of these five are recommended for clinical diagnosis. Management of DN includes control of hyperglycaemia, other cardiovascular risk factors; lipoic acid and L carnitine. For neuropathic pain, analgesics, non-steroidal anti-inflammatory drugs, antidepressants, and anticonvulsants are recommended. The treatment of autonomic neuropathy is symptomatic.

Abbreviations: DN, diabetic neuropathy; DM, diabetes mellitus; DSPN, distal symmetrical polyneuropathy; NCV, nerve conduction velocity; ARI, aldolase reductase inhibitor; ALC, acetyl L carnitine; NGF, nerve growth factor; CIDP, chronic inflammatory demyelinating neuropathy

Keywords: neuropathy; diabetes; treatment; classification; pathophysiology

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