[Diabetic neuropathy--a clinical review].

BACKGROUND

Diabetic neuropathy is an often overlooked common complication of diabetes.

METHODS

This review is based on papers identified on Medline and our own clinical experience.

RESULTS AND INTERPRETATION

Diabetic neuropathies can be classified as reversible or chronic. The most common type is the chronic, progressive distal symmetric polyneuropathy where sensory symptoms in the lower limbs dominate. These patients often lose their protective sensibility and are at risk of foot ulcers and amputations; distressing pain is another symptom of this disorder. Autonomic neuropathy is often a feature of progressive polyneuropathy, but is rarely symptomatic. Mononeuropathies affecting femoral, truncal or ocular nerves are among the reversible neuropathies of diabetes. Distal symmetric diabetic neuropathy is very common; overall prevalence among diabetic patients is around 20-30%. The prevalence increases with the duration of the disease as well as with poor glycaemic control, height and age. The pathogenesis of diabetic neuropathies is not clear, but possibly involves a complex of metabolic factors inducing nerve ischaemia. We recommend yearly screening for most diabetic patients with a simple screening instrument consisting of four questions and four simple tests. Tight glycaemic control has been shown to protect against or delay the occurrence of neuropathy. Tricyclic antidepressants are still the drugs of choice against painful diabetic neuropathy, but gabapentin and tramadol are new alternatives.