Diabetic Neuropathy: A Position Statement by the American Diabetes Association
- Rodica Pop-Busui1,
- Andrew J.M. Boulton2,
- Eva L. Feldman3,
- Vera Bril4,
- Roy Freeman5,
- Rayaz A. Malik6,
- Jay M. Sosenko7 and
- Dan Ziegler8
- 1Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI
- 2University of Manchester and the Royal Infirmary, Manchester, U.K.
- 3Department of Neurology, University of Michigan, Ann Arbor, MI
- 4Department of Neurology, University of Toronto, Toronto, Ontario, Canada
- 5Department of Neurology, Harvard Medical School, Boston, MA
- 6Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar and New York, NY
- 7Division of Endocrinology, University of Miami Miller School of Medicine, Miami, FL
- 8German Diabetes Center Düsseldorf, Leibniz Center for Diabetes Research at Heinrich Heine University, and Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
- Corresponding author: Rodica Pop-Busui, rpbusui{at}umich.edu.
Introduction
Diabetic neuropathies are the most prevalent chronic complications of diabetes. This heterogeneous group of conditions affects different parts of the nervous system and presents with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is important for a number of reasons:
Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be present in patients with diabetes and may be treatable by specific measures.
A number of treatment options exist for symptomatic diabetic neuropathy.
Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk for injuries to their insensate feet.
Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life.
Among the various forms of diabetic neuropathy, distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are by far the most studied (1–4). There are several atypical forms of diabetic neuropathy as well (1–4). Patients with prediabetes may also develop neuropathies that are similar to diabetic neuropathies (5–10). Table 1 provides a comprehensive classification scheme for the diabetic neuropathies.
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Classification for diabetic neuropathies
Due to a lack of treatments that target the underlying nerve damage, prevention is the key component of diabetes care. Screening for symptoms and signs of diabetic neuropathy is also critical in clinical practice, as it may detect the earliest stages of neuropathy, enabling early intervention. Although screening for rarer atypical forms of diabetic neuropathy may be warranted, DSPN and autonomic neuropathy are the most common forms encountered in practice. The strongest available evidence regarding treatment pertains to these forms.
This Position Statement is based on several recent technical reviews, to which the reader is referred for detailed discussion …
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