Spectrum of diabetic neuropathies

The diabetic state results in neuropathy. The main causative mechanism is hyperglycemia, although microvascular involvement, hypertriglyceridemia, as well as genetic and immune mechanisms may be contributory. There is a growing spectrum of types of diabetic neuropathies that differ based on the type...

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Bibliographic Details
Published in:Diabetology international 2020-04, Vol.11 (2), p.87-96
Main Authors: Sasaki, Hideyuki, Kawamura, Nobutoshi, Dyck, Peter J., Dyck, P. James B., Kihara, Mikihiro, Low, Phillip A.
Format: Article
Language:English
Subjects:
Autonomic nervous system
Burning
Diabetes
Diabetes mellitus
Diabetic neuropathy
Endocrinology
Fibers
Hyperglycemia
Hypertriglyceridemia
Hypotension
Inflammation
Intestine
Medicine
Medicine & Public Health
Metabolic Diseases
Microvasculature
Nerves
Pain
Phenotypes
Review
Review Article
Sensory neurons
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Summary:The diabetic state results in neuropathy. The main causative mechanism is hyperglycemia, although microvascular involvement, hypertriglyceridemia, as well as genetic and immune mechanisms may be contributory. There is a growing spectrum of types of diabetic neuropathies that differ based on the type of fibers involved (e.g. myelinated, unmyelinated, autonomic, somatic), distribution of nerves involved, and mechanisms of neuropathy. The most common type is distal sensory neuropathy (DSN), which affects the distal ends of large myelinated fibers, more often sensory than motor, and is often asymptomatic. The next-most common is distal small fiber neuropathy (DSFN), which largely affects the unmyelinated fibers and carries the phenotype of burning feet syndrome. Diabetic autonomic neuropathy (DAN) occurs when widespread involvement of autonomic unmyelinated fibers occurs, and patients can be incapacitated with orthostatic hypotension as well as neurogenic bladder and bowel involvement. Radiculoplexus diabetic neuropathy causes proximal weakness and pain, usually in the lower extremity, and has a combination of immune, inflammatory, and vascular mechanisms. The nerve roots and plexus are involved. These patients present with proximal weakness of a subacute onset, often with severe pain and some autonomic failure. Finally, rapid and sustained reduction of blood glucose can result in treatment-induced diabetic neuropathy (TIND), which largely affects the sensory and autonomic fibers. This occurs if HbA1c is rapidly reduced within 3 months, and the likelihood is proportional to the original A1c and the size of the reduction.
ISSN:2190-1678
2190-1686
DOI:10.1007/s13340-019-00424-7