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NDT Advance Access originally published online on July 13, 2004
Nephrology Dialysis Transplantation 2004 19(9):2170-2175; doi:10.1093/ndt/gfh398
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Nephrol Dial Transplant Vol. 19 No. 9 © ERA-EDTA 2004; all rights reserved

Editorial Comment

Polyneuropathy in the diabetic patient—update on pathogenesis and management

Dan Ziegler

German Diabetes Research Institute, Leibniz Institute at the Heinrich Heine University, Düsseldorf, Germany

Correspondence and offprint requests to: Professor Dan Ziegler, FRCP (Edin), Deutsches Diabetes-Forschungsinstitut an der Heinrich-Heine-Universität, Auf’m Hennekamp 65, D-0225 Düsseldorf, Germany. Email: dan.ziegler@ddfi.uni-duesseldorf.de

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   Clinical impact of diabetic polyneuropathy
 
Distal symmetrical sensory or sensorimotor polyneuropathy (DSP) affects ~30% of the hospital-based population and 20% of community-based samples of diabetic patients. The incidence of DSP is ~2% per year. The most important aetiological factors that have been associated with DSP are poor glycaemic control, diabetes duration and height, with possible roles for hypertension, age, smoking, hypoinsulinaemia and dyslipidaemia [1]. Moreover, DSP is related to both lower extremity impairments such as diminished position sense and functional limitations such as walking ability. There is accumulating evidence suggesting that not only surrogate markers of microangiopathy such as albuminuria, but also those indicating the presence of polyneuropathy such as impaired nerve conduction velocity (NCV) and vibration perception threshold (VPT) predict mortality in diabetic patients [2,3]. Elevated VPT also predicts the development of neuropathic foot ulceration, one of the most common causes for hospital admission and lower limb amputations . . . [Full Text of this Article]



   Pathogenetic mechanisms
 


   Treatment based on pathogenetic concepts
 
Aldose reductase inhibitors (ARIs)
Antioxidants ({alpha}-lipoic acid) and PARP inhibitors
Vasodilators
Nerve growth factor
PKC ß inhibitor (ruboxistaurin)
C-peptide


   New agents for treatment of painful diabetic neuropathy
 
Antidepressants
Anticonvulsants
Strong opioids for add-on treatment
Non-pharmacological treatment


   Conclusions
 

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A Verrotti, G Loiacono, A Mohn, and F Chiarelli
New insights in diabetic autonomic neuropathy in children and adolescents
Eur. J. Endocrinol., December 1, 2009; 161(6): 811 - 818.
[Abstract] [Full Text] [PDF]