Kazamel Mohamed, Dyck Peter J
Neuromuscular Pathology Laboratories, Department of Neurology, Mayo Clinic, Rochester, USA.
Peripheral Neuropathy Research Laboratory, Department of Neurology, Mayo Clinic, Rochester, USA
Prosthet Orthot Int. 2015 Feb;39(1):7-16. doi: 10.1177/0309364614536764.
Diabetes mellitus is among the most common causes of peripheral neuropathy worldwide. Sensory impairment in diabetics is a major risk factor of plantar ulcers and neurogenic arthropathy (Charcot joints) causing severe morbidity and high health-care costs.
To discuss the different patterns of sensory alterations in diabetic neuropathies and their anatomical basis.
Literature review.
Review of the literature discussing different patterns of sensory impairment in diabetic neuropathies.
The different varieties of diabetic neuropathies include typical sensorimotor polyneuropathy (lower extremity predominant, length-dependent, symmetric, sensorimotor polyneuropathy presumably related to chronic hyperglycemic exposure, and related metabolic events), entrapment mononeuropathies, radiculoplexus neuropathies related to immune inflammatory ischemic events, cranial neuropathies, and treatment-related neuropathies (e.g. insulin neuritis). None of these patterns are unique for diabetes, and they can occur in nondiabetics. Sensory alterations are different among these prototypic varieties and are vital in diagnosis, following course, treatment options, and follow-up of treatment effects.
Diabetic neuropathies can involve any segment of peripheral nerves from nerve roots to the nerve endings giving different patterns of abnormal sensation. It is the involvement of small fibers that causes positive sensory symptoms like pain early during the course of disease, bringing subjects to physician's care.
This article emphasizes on the fact that diabetic neuropathies are not a single entity. They are rather different varieties of conditions with more or less separate pathophysiological mechanisms and anatomical localization. Clinicians should keep this in mind when assessing patients with diabetes on the first visit or follow-up.
糖尿病是全球周围神经病变最常见的病因之一。糖尿病患者的感觉障碍是足底溃疡和神经源性关节病（夏科关节）的主要危险因素，会导致严重的发病率和高昂的医疗费用。
探讨糖尿病神经病变感觉改变的不同模式及其解剖学基础。
文献综述。
回顾讨论糖尿病神经病变感觉障碍不同模式的文献。
糖尿病神经病变的不同类型包括典型的感觉运动性多发性神经病变（以下肢为主，长度依赖性、对称性、感觉运动性多发性神经病变，可能与长期高血糖暴露及相关代谢事件有关）、卡压性单神经病变、与免疫炎性缺血事件相关的神经根丛神经病变、颅神经病变以及治疗相关神经病变（如胰岛素神经炎）。这些模式均非糖尿病所特有，也可发生于非糖尿病患者。这些典型类型的感觉改变各不相同，对诊断、病程观察、治疗选择及治疗效果随访至关重要。
糖尿病神经病变可累及从神经根到神经末梢的周围神经任何节段，产生不同模式的异常感觉。正是小纤维受累在疾病早期导致疼痛等阳性感觉症状，促使患者就医。
本文强调糖尿病神经病变并非单一实体这一事实。它们是不同类型的疾病，具有或多或少独立的病理生理机制和解剖定位。临床医生在初次接诊或随访糖尿病患者时应牢记这一点。
