An Overview of Diabetic Neuropathy

Abstract

Purpose of Review: Diabetic Neuropathies are a heterogeneous by their symptoms, pattern of neurologic involvement, course, risk covariates, pathologic alterations, and underlying mechanisms that result into mono- and polyneuropathies, plexopathies and radiculopathies. It also ranges from subclinical functional impairment of cardiovascular reflexes and sudomotor functions to severe cardiovascular, gastrointestinal, or genitourinary dysfunction. Orthostatic hypotension, Resting tachycardia, and Heart Rate unresponsiveness to respiration are the hallmarks of Diabetic Autonomic Neuropathy. Diabetic Peripheral Neuropathy greatly affects all areas of a patient’s life, including mood, sleep, self-worth, independence, ability to work, and interpersonal relationships. This review provides an overview of definition, etiopathogenesis, clinical assessment, diagnosis and management of the patients with Diabetic Neuropathies. Summary and Results: Good clinical history and complete physical examination are the basis of assessment followed by therapeutic and laboratory studies. Strict glycemic control along with early detection and control of hyperlipidemia and hypertension, daily aspirin, smoking cessation and alcohol consumption in moderation may help to prevent, delay, or slow the progression of Diabetic Neuropathy. The main classes of agents used to treat Diabetic Peripheral Neuropathic pain include Tricyclic antidepressants, Anticonvulsants, Serotonin-Norepinephrine Reuptake Inhibitors, Opiates and Opiate-like substances, and topical medications. However, only two medications are approved specifically for the treatment of Diabetic Peripheral Neuropathic pain: Pregabalin and Duloxetine. Management must be individualized for each patient based on efficacy, side effects profiles and drug accessibility including cost.