Diabetic neuropathies. Diabetologia

The Strelitz Diabetes Institutes, Department of Internal Medicine, Eastern Virginia Medical School, Norfolk, Virginia 23510, USA.
Diabetologia (Impact Factor: 6.67). 09/2000; 43(8):957-73. DOI: 10.1007/s001250051477
Source: PubMed


Diabetic neuropathy is a common complication of diabetes that is often associated both with considerable morbidity and mortality. The epidemiology and natural course of diabetic neuropathy is clouded with uncertainty, largely due to confusion regarding the definition and measurement of this disorder. The recent resurgence of interest in the vascular hypothesis, oxidative stress, the neurotrophic hypothesis and the possibility of the role of autoimmunity have opened up new avenues of investigation for therapeutic intervention. Paralleling our increased understanding of the pathogenesis of diabetic neuropathy, there must be refinements in our ability to measure quantitatively the different types of defects that occur in this disorder, so that appropriate therapies can be targeted to specific fibre types. These tests must be validated and standardised to allow comparability between studies and a more meaningful interpretation of study results. Our ability to manage successfully the many different manifestations of diabetic neuropathy depends ultimately on our success in uncovering the pathogenic processes underlying this disorder.

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Available from: Aaron I Vinik, Dec 04, 2014
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    • "While some people with neuropathy experience symptoms that manifest as burning sensation, sharp pain, numbness, and pain to normal touch, the majority have insidious symptoms, including the inability to feel, assess temperature, or sense painful stimuli. Loss of pedal protective sensation increases risk for microtrauma and hidden injury to the foot, which can cause infections, calluses, and foot ulceration [9] [10]. Although not all individuals with type 2 diabetes develop peripheral neuropathy, chronically elevated blood glucose "
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    ABSTRACT: Peripheral neuropathy and loss of somatosensation in older adults with type 2 diabetes can increase risk of falls and disability. In nondiabetic older adult population Tai Chi has been shown to enhance balance and fitness through improvements in somatosensation and neuromuscular control, and it is unclear if Tai Chi would elicit similar benefits in older adults with diabetes. Therefore, the purpose of this study was to investigate the effects of an 8-week, three-hour-per-week Tai Chi intervention on peripheral somatosensation in older adults with type 2 diabetes. Participants were eight Hispanic older adults with type 2 diabetes who participated in the Tai Chi intervention and a convenience sample of Hispanic older adults as a referent group. Baseline and postintervention assessments included ankle proprioception, foot tactile sense, plantar pressure distribution, balance, and fitness. After intervention, older adults with type 2 diabetes showed significant improvements in ankle proprioception and fitness and decreased plantar pressure in the forefoot, with no statistical effect noted in balance or tactile sensation. Study results suggest that Tai Chi may be beneficial for older adults with diabetes as it improves ankle proprioception; however, study findings need to be confirmed in a larger sample size randomized controlled trial.
    Full-text · Article · Nov 2015 · Evidence-based Complementary and Alternative Medicine
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    • "A frequent cause of peripheral neuropathy is type 2 diabetes mellitus [4]. In this group of patients, the frequency of balance symptoms may be related to both the time elapsed since the diabetes was diagnosed and the history of peripheral neuropathy and retinopathy [5]. "
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    ABSTRACT: Aim: To assess the influence of peripheral neuropathy, gender, and obesity on the postural stability of patients with type 2 diabetes mellitus. Methods: 151 patients with no history of otology, neurology, or orthopaedic or balance disorders accepted to participate in the study. After a clinical interview and neuropathy assessment, postural stability was evaluated by static posturography (eyes open/closed on hard/soft surface) and the "Up & Go" test. Results: During static posturography, on hard surface, the length of sway was related to peripheral neuropathy, gender, age, and obesity; on soft surface, the length of sway was related to peripheral neuropathy, gender, and age, the influence of neuropathy was larger in males than in females, and closing the eyes increased further the difference between genders. The mean time to perform the "Up & Go" test was 11.6 ± 2.2 sec, with influence of peripheral neuropathy, gender, and age. Conclusion: In order to preserve the control of static upright posture during conditions with deficient sensory input, male patients with type 2 diabetes mellitus with no history of balance disorders may be more vulnerable than females, and obesity may decrease the static postural control in both males and females.
    Full-text · Article · Sep 2014 · Journal of Diabetes Research
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    • "In fact, the onset is so gradual that the disease may go undiagnosed for years. Neuropathic pain may be severe when it is present but this type of pain is reported to occur in only 11% to 32% of individuals with DPN [7]. DPN leads to a number of impairments and functional limitations including foot ulceration and subsequent lower-extremity amputation [8]; in Korea between 2000 and 2002, 44.8% of foot amputee patients had diabetes [9]. "
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    ABSTRACT: Diabetic peripheral neuropathy (DPN) is the most common complication associated with diabetes. DPN can present as a loss of sensation, may lead to neuropathic ulcers, and is a leading cause of amputation. Reported estimates of the prevalence of DPN vary due to differences in study populations and diagnostic criteria. Furthermore, the epidemiology and clinical characteristics of DPN in Korean patients with type 2 diabetes mellitus (T2DM) are not as well understood as those of other complications of diabetes such as retinal and renal disease. Recently, the Diabetic Neuropathy Study Group of the Korean Diabetes Association (KDA) conducted a study investigating the impact of DPN on disease burden and quality of life in patients with T2DM and has published some data that are representative of the nation. This review investigated the prevalence and associated clinical implications of DPN in Korean patients with diabetes based on the KDA study.
    Full-text · Article · Feb 2014 · Diabetes & metabolism journal
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