Diabetic Neuropathies

James W. Russell, MD, MS, FRCP, FACP, FAAN; Lindsay A. Zilliox, MD Peripheral Nervous System Disorders p. 1226-1240 October 2014, Vol.20, No.5 doi: 10.1212/01.CON.0000455884.29545.d2
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Purpose of Review: This article provides an overview for understanding the diagnosis, pathogenesis, and management of diabetic neuropathy.

Recent Findings: New information about the pathogenesis of diabetic neuropathy continues to emerge, which will lead to identifying new drug targets. It is clear that the natural history of diabetic neuropathy is changing and the rate of progression is slowing. This is likely because of a combination of earlier diagnosis, improved glycemic management, and improved control of related complications such as hyperlipidemia and hypertension. Early diagnosis is critical, and small fiber neuropathy or subclinical diabetic neuropathy may be reversed or significantly improved with appropriate intervention. The American Academy of Neurology recently published guidelines for the treatment of painful diabetic neuropathy.

Summary: Diabetic neuropathy is common and can present with varied clinical presentations discussed in this article. Although treatment currently focuses on pain management, attention should be paid to potential risk factors for neuropathy. For example, glycemic control, hyperlipidemia, and hypertension should be managed with diet, exercise, and medications. Class I or II clinical studies indicate that pregabalin, duloxetine, amitriptyline, gabapentin, and opioids are effective in the management of diabetic neuropathic pain.

Address correspondence to Dr James W. Russell, Department of Neurology, 110 S Paca Street, Floor 3, Baltimore, MD 21201, [email protected].

Relationship Disclosure: Dr Russell’s institution receives grants from the Department of Veterans Affairs and the NIH. Dr Zilliox receives salary support from the Department of Veterans Affairs.

Unlabeled Use of Products/Investigational Use Disclosure: Drs Russell and Zilliox discuss the unlabeled use of α-lipoic acid for the treatment of diabetic neuropathies.

© 2014 American Academy of Neurology