Diabetic peripheral neuropathy

Disease modifying treatment available:
Time critical diagnosis and management:
Lateralising:

Definition

None



Taxotomy

Subclassifications Epidemiology Clinical features
Peripheral neuropathy None


Aetiology

Diabetic peripheral neuropathy onset is associated with the severity and duration of diabetes. High levels of glycosylated haemoglobin have consistently been associated with increased risk of diabetic peripheral neuropathy in prospective cohort studies. Long durations of diabetes have been associated with increased risk regardless of age and HbA1c.

Disorder Clinical features Associated features Investigations Disease modifying treatment available Time critical
Diabetes mellitus type 1 Peripheral neuropathy
Diabetic ketoacidosis
Nephrotic syndrome
Diabetes mellitus type 2 Peripheral neuropathy
Nephrotic syndrome


Clinical features


None

Diabetic peripheral neuropathy may cause the following:




Investigations


Laboratory investigations should be undertaken to exclude other reversible causes of peripheral neuropathy. Nerve conduction studies are not required and should be requested only if atypical features are present and the diagnosis is in question.

None


Laboratory Investigation Result

Treatment


Management should focus on:
- Excellent blood sugar control - this appears to be more valuable in type 1 diabetes than type 2
- General optimisation of vascular risk factors including lipids, blood pressure and obesity
- Pain control

Non-pharmacological interventions for pain control that have an evidence base include cognitive behavioural therapy and acupuncture.




Research


Open questions

It is not yet clear whether newer anti-diabetes medications such as GLP-1 agonists, SLGT2 inhibitors and DDP-4 inhibitors are effective.