Clinical Manifestations and Current Treatment Options for Diabetic Neuropathies

Carolina M. Casellini, MD; Aaron I. Vinik, MD, PhD, FCP, MACP

Disclosures

Endocr Pract. 2007;13(5):550-566. 

In This Article

Definition

DN is defined as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes mellitus after the exclusion of other causes. A careful clinical examination is needed for the diagnosis because asymptomatic neuropathy is common.[6] A minimum of 2 abnormalities (symptoms, signs, nerve conduction abnormalities, quantitative sensory test results, or quantitative autonomic test results) is required for diagnosis and, for clinical studies, 1 of these 2 abnormalities should include quantitative test results or electrophysiology findings.[6,7] Standardized testing using a neurologic symptom score (Appendix 1) and a neurologic impairment score (Appendix 2)—which are used to calculate a total neuropathy score ( Table 1 )—to quantify weakness, loss of reflexes, and sensory deficits has proved invaluable in diagnosis and monitoring of progress and is indispensable for clinical trials.

Table 2 describes the classification proposed by Thomas[9] and modified by us.[8,10] Different forms of DN often coexist in the same patient (eg, distal polyneuropathy and carpal tunnel syndrome).

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