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JPMA. the Journal of the Pakistan... Jun 2014To conclude, diabetes is associated with a variety of chronic and acute neuropathies, the commonest form being distal symmetric polyneuropathy. Performing an annual... (Review)
Review
To conclude, diabetes is associated with a variety of chronic and acute neuropathies, the commonest form being distal symmetric polyneuropathy. Performing an annual screening through a good neurological history and clinical examination and using a sensitive screening tool can facilitate an early diagnosis. More sensitive and quantitative measures of detecting early peripheral nerve injury including skin biopsy for intra-epidermal and dermal nerve fiber density and confocal corneal microscopy, hold promise to identify neuropathy patients early in their disease course.
Topics: Diabetic Neuropathies; Humans; Prevalence
PubMed: 25252500
DOI: No ID Found -
The Medical Clinics of North America Nov 1988Diabetic neuropathy is a common complication of diabetes mellitus with significant morbidity and mortality. Hyperglycemia with its secondary metabolic, vascular, and... (Review)
Review
Diabetic neuropathy is a common complication of diabetes mellitus with significant morbidity and mortality. Hyperglycemia with its secondary metabolic, vascular, and enzymatic consequences is most likely to be the predominant cause. The clinical manifestations includes a wide range of somatic and autonomic syndromes. Painful diabetic neuropathy may require symptomatic treatment. The precise role of therapies such as continuous subcutaneous insulin therapy and aldose reductase inhibitors remains to be clarified.
Topics: Autonomic Nervous System Diseases; Diabetic Neuropathies; Female; Humans; Male; Nerve Fibers; Nervous System Diseases; Pain; Sensation
PubMed: 3054362
DOI: 10.1016/s0025-7125(16)30716-7 -
Handbook of Clinical Neurology 2014Foot ulceration and Charcot neuroarthropathy (CN) are well recognized and documented late sequelae of diabetic peripheral, somatic, and sympathetic autonomic neuropathy.... (Review)
Review
Foot ulceration and Charcot neuroarthropathy (CN) are well recognized and documented late sequelae of diabetic peripheral, somatic, and sympathetic autonomic neuropathy. The neuropathic foot, however, does not ulcerate spontaneously: it is a combination of loss of sensation due to neuropathy together with other factors such as foot deformity and external trauma that results in ulceration and indeed CN. The commonest trauma leading to foot ulcers in the neuropathic foot in Western countries is from inappropriate footwear. Much of the management of the insensate foot in diabetes has been learned from leprosy which similarly gives rise to insensitive foot ulceration. No expensive equipment is required to identify the high risk foot and recently developed tests such as the Ipswich Touch Test and the Vibratip have been shown to be useful in identifying the high risk foot. A comprehensive screening program, together with education of high risk patients, should help to reduce the all too high incidence of ulceration in diabetes. More recently another very high risk group has been identified, namely patients on dialysis, who are at extremely high risk of developing foot ulceration; this should be preventable. The most important feature in management of neuropathic foot ulceration is offloading as patients can easily walk on active foot ulcers due to the loss of pain sensation. Infection should be treated aggressively and if there is any evidence of peripheral vascular disease, arteriography and appropriate surgical management is also indicated. CN often presents with a unilateral hot, swollen foot and any patient presenting with these features known to have neuropathy should be treated as a Charcot until this is proven otherwise. Most important in the management of acute CN is offloading, often in a total contact cast.
Topics: Animals; Diabetes Mellitus; Diabetic Foot; Diabetic Neuropathies; Glycemic Index; Humans
PubMed: 25410217
DOI: 10.1016/B978-0-444-53480-4.00008-4 -
International Journal of Molecular... May 2021Diabetic neuropathy (DN), the most common chronic and progressive complication of diabetes mellitus (DM), strongly affects patients' quality of life. DN could be present... (Review)
Review
Diabetic neuropathy (DN), the most common chronic and progressive complication of diabetes mellitus (DM), strongly affects patients' quality of life. DN could be present as peripheral, autonomous or, clinically also relevant, uremic neuropathy. The etiopathogenesis of DN is multifactorial, and genetic components play a role both in its occurrence and clinical course. A number of gene polymorphisms in candidate genes have been assessed as susceptibility factors for DN, and most of them are linked to mechanisms such as reactive oxygen species production, neurovascular impairments and modified protein glycosylation, as well as immunomodulation and inflammation. Different epigenomic mechanisms such as DNA methylation, histone modifications and non-coding RNA action have been studied in DN, which also underline the importance of "metabolic memory" in DN appearance and progression. In this review, we summarize most of the relevant data in the field of genetics and epigenomics of DN, hoping they will become significant for diagnosis, therapy and prevention of DN.
Topics: Animals; Diabetic Neuropathies; Epigenesis, Genetic; Epigenomics; Genetic Predisposition to Disease; Humans; Inflammation; Peripheral Nervous System
PubMed: 34063061
DOI: 10.3390/ijms22094887 -
Seminars in Neurology Jun 2005Diabetic neuropathy is not a single entity but manifests as several different clinical syndromes. It is likely that different pathophysiological mechanisms contribute to... (Review)
Review
Diabetic neuropathy is not a single entity but manifests as several different clinical syndromes. It is likely that different pathophysiological mechanisms contribute to the development of the neuropathy, including metabolic alterations, microvascular changes, and inflammatory changes. A summary of the underlying pathophysiological mechanisms and clinical aspects of different diabetic neuropathies are outlined in this article.
Topics: Diabetic Neuropathies; Education, Medical, Continuing; Humans; Motor Neurons; Neurons, Afferent
PubMed: 15937732
DOI: 10.1055/s-2005-871325 -
Experimental and Clinical Endocrinology... Jul 2014
Topics: Algorithms; Diabetic Neuropathies; Diagnosis, Differential; Diagnostic Techniques, Endocrine; Diagnostic Techniques, Neurological; Disease Progression; Humans; Mass Screening; Monitoring, Physiologic; Pain Management
PubMed: 25014092
DOI: 10.1055/s-0034-1366435 -
Lancet (London, England) May 1989
Review
Topics: Diabetic Neuropathies; Edema; Humans; Magnetic Resonance Imaging; Peripheral Nervous System Diseases; Sural Nerve
PubMed: 2566054
DOI: No ID Found -
Journal of Dietary Supplements 2019Diabetic neuropathy is a chronic complication of diabetes mellitus affecting about 50% of patients. Its symptoms include decreased motility and severe pain in peripheral... (Review)
Review
Diabetic neuropathy is a chronic complication of diabetes mellitus affecting about 50% of patients. Its symptoms include decreased motility and severe pain in peripheral parts. The pathogenesis involved is an abnormality in blood vessels that supply the peripheral nerves, metabolic disorders such as myo-inositol depletion, and increased nonenzymatic glycation. Moreover, oxidative stress in neurons results in activation of multiple biochemical pathways, which results in the generation of free radicals. Apart from available marketed formulations, extensive research is being carried out on herbal-based natural products to control hyperglycemia and its associated complications. This review is focused to provide a summary on diabetic neuropathy covering its etiology, types, and existing work on herbal-based therapies, which include pure compounds isolated from plant materials, plant extracts, and Ayurvedic preparations.
Topics: Animals; Diabetic Neuropathies; Drugs, Chinese Herbal; Humans; Hyperglycemia; Medicine, Ayurvedic; Oxidative Stress; Phytotherapy; Plant Extracts
PubMed: 29580105
DOI: 10.1080/19390211.2018.1441203 -
Seminars in Neurology 1998Diabetes mellitus leads to several recognizable clinicopathologic neuropathic syndromes. Diagnosis and evaluation requires a thorough history and neurologic examination,... (Review)
Review
Diabetes mellitus leads to several recognizable clinicopathologic neuropathic syndromes. Diagnosis and evaluation requires a thorough history and neurologic examination, nerve conductions and needle electromyography (EMG), blood studies, consideration of cerebrospinal fluid analysis, and nerve and muscle biopsy in the most severely affected patients. Microangiopathy is the commonest cause of diabetic neuropathy, associated with potentially reversible metabolic, immunologic, or ischemic injury. Tight glycemic control and symptomatic therapy is beneficial in some patients but does not prevent progression of neuropathy especially in patients with severe motor and gait disability. Intravenous immune globulin is a novel therapy in diabetic patients. It may be considered in selected patients well characterized by clinical, electrophysiologic, histopathologic studies, and one of the following progressive syndromes: mononeuropathy multiplex, primary demyelinating motor or sensorimotor neuropathy, and peripheral nerve perivasculitis or microvasculitis associated with vascular membrane attack complex protein deposits.
Topics: Diabetes Mellitus, Type 2; Diabetic Neuropathies; Education, Medical, Continuing; Humans; Male; Middle Aged
PubMed: 9562671
DOI: 10.1055/s-2008-1040865 -
Pharmacological Research Feb 2014Diabetic neuropathy is a heterogeneous group of disorders with extremely complex pathophysiology and affects both somatic and autonomic components of the nervous system.... (Review)
Review
Diabetic neuropathy is a heterogeneous group of disorders with extremely complex pathophysiology and affects both somatic and autonomic components of the nervous system. Neuropathy is the most common chronic complication of diabetes mellitus. Metabolic disruptions in the peripheral nervous system, including altered protein kinase C activity, and increased polyol pathway activity in neurons and Schwann cells resulting from hyperglycemia plays a key role in the development of diabetic neuropathy. These pathways are related to the metabolic and/or redox state of the cell and are the major source of damage. Activation of these metabolic pathways leads to oxidative stress, which is a mediator of hyperglycemia induced cell injury and a unifying theme for all mechanisms of diabetic neuropathy. The therapeutic intervention of these metabolic pathways is capable of ameliorating diabetic neuropathy but therapeutics which target one particular mechanism may have a limited success. Available therapeutic approaches are based upon the agents that modulate pathogenetic mechanisms (glycemic control) and relieve the symptoms of diabetic neuropathy. This review emphasizes the pathogenesis, presently available therapeutic approaches and future directions for the management of diabetic neuropathy.
Topics: Diabetic Neuropathies; Humans; Models, Biological; Molecular Targeted Therapy; Oxidative Stress
PubMed: 24373831
DOI: 10.1016/j.phrs.2013.12.005