Diabetes and Metabolic Disorders and the Peripheral Nervous System

Christopher H. Gibbons, MD, MMSc, FAAN Peripheral Nerve and Motor Neuron Disorders p. 1161-1183 October 2020, Vol.26, No.5 doi: 10.1212/CON.0000000000000906
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PURPOSE OF REVIEW This article provides an up-to-date review of the manifestations of neuropathy seen in the setting of diabetes and other metabolic disorders.

RECENT FINDINGS Although a number of metabolic disorders cause or are associated with peripheral neuropathy, the neuropathies associated with glucose dysregulation make up the vast majority of cases. Recent investigations have determined major differences in the neuropathies associated with type 1 and type 2 diabetes. Neuropathy in type 1 diabetes is closely linked to glycemic control, whereas neuropathy in type 2 diabetes is linked to dyslipidemia, central obesity, hypertension, insulin resistance, and glucose control. Although length-dependent axonal distal symmetric polyneuropathy is the most common clinical presentation, diabetes is also associated with acute, asymmetric, painless, and autonomic neuropathies.

SUMMARY The prevalence of diabetes and metabolic syndrome is increasing across the globe. The need to recognize and treat the wide array of clinical manifestations of neuropathy detected in individuals with metabolic disorders will continue to grow. As a consequence, an increasing number of well-trained physicians who can manage these patients is needed. At present, treatment is largely focused on prevention and symptomatic management. Investments into funding for both basic and clinical science are necessary to bring novel therapeutic interventions into clinical practice.

Address correspondence to Dr Christopher Gibbons, Center for Autonomic and Peripheral Nerve Disorders, Beth Israel Deaconess Medical Center, 1 Deaconess Rd, Palmer 111, Boston, MA 02215, [email protected].

RELATIONSHIP DISCLOSURE: Dr Gibbons has received personal compensation for serving as a scientific advisor for Lundbeck and Theravance Biopharma and as an associate editor for Autonomic Neuroscience: Basic and Clinical, research/grant support from Grifols, and publishing royalties from UpToDate, Inc. Dr Gibbons has held stock/stock options in Cutaneous Neurodiagnostics, LLC, and has given expert medical testimony.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Dr Gibbons reports no disclosure.

© 2020 American Academy of Neurology.