Clinical Manifestations and Current Treatment Options for Diabetic Neuropathies

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


Endocr Pract. 2007;13(5):550-566. 

In This Article


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).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: