Diabetic Neuropathy

Diabetic Neuropathy is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

Classification

Diabetic neuropathy can be classified as (1) subclinical neuropathy, determined by abnormalities in electrodiagnostic and quantitative sensory testing; (2) diffuse symmetrical polyneuropathy with distal symmetric sensorimotor losses ± autonomic syndromes; and (3) focal syndromes.1

Epidemiology

Distal symmetric polyneuropathy (DPN) is the most common neuropathy in developed countries and accounts for more hospitalizations than all the other diabetic complications combined. Sensorimotor DPN is a major risk factor for foot trauma, ulceration, and Charcot arthropathy and is responsible for 50%–75% of nontraumatic amputations.2,1

Prevention

  • Sensation in the lower extremities should be documented at least annually, using a combination of modalities such as a light-touch monofilament, tuning fork (frequency of 128 Hz), pinprick, or temperature.
  • Foot examination should be conducted at least annually to evaluate the presence of musculoskeletal deformities, skin changes, and pulses, in addition to the sensory examination.

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