Clinical Importance of Diabetic Neuropathy

Tae Sun Park

doi:10.4093/jkd.2018.19.3.147

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Park: Clinical Importance of Diabetic Neuropathy

Focused Issue

J Korean Diabetes 2018;19(3):147-152.

Published online: 10 January 2018

DOI: https://doi.org/10.4093/jkd.2018.19.3.147

Clinical Importance of Diabetic Neuropathy

Tae Sun Park^1,²

¹Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea

²Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea

Corresponding author: Tae Sun Park Division of Endocrinology and Metabolism, Department of Internal Medicine, Chonbuk National University Medical School, 20 Geonji-ro, Deokjin-gu, Jeonju 54907, Korea, E-mail: pts@jbnu.ac.kr

Received 30 July 2018 Accepted 13 August 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Diabetic neuropathy is a complex and common disorder with multiple etiologies and affects about 43.1% of the Korean diabetes population. Good glycemic control slows progression of diabetic neuropathy in subjects with type 1 diabetes but seems to provide little benefit in subjects with type 2 diabetes. Moreover, neuropathy has been shown to develop in humans at stages of prediabetes and in the absence of overt hyperglycemia. Given the increasing incidence of both type 1 and type 2 diabetes and obesity and the impact of diabetic neuropathy on the quality of life of patients, a strategy for early diagnosis and discovery of an effective treatment is important for prevention and progression of diabetic neuropathy. Approximately 14.4% of Korean diabetics with neuropathy have associated pain, and management of this pain has been unsuccessful for many clinicians and patients. Choice of the correct drug(s), dosage, and patient management seems to be based on individualized conditions and needs. Overall, for good management and prevention for diabetic foot morbidities, early and proper diagnosis of diabetic neuropathy is essential, and simple and precise diagnostic methods must be developed.

Keywords: Diabetic neuropathy, Glycemic control, Pain management

References

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Table 1.

Diagnostic criteria of diabetic neuropathy

	Possible DN	Probable DN	Confirmed DN	Subclinical DN
Symptoms	+/–	+	+ or –	–
Signs	–/+	+	– or +	–
QSTs	+	+	+	+
NC abnormality	–	–	+	+

DN, diabetic neuropathy; QSTs, quantitative sensory tests; NC, nerve conduction.

Table 2.

Symptom-based classification of neuropathic pain

Positive sensory symptoms	Negative sensory symptoms
Paresthesia	Loss of sensory quality
Dysesthesia	Due to system involved: hypoesthesia, hypoalgesia,
Spontaneous pain (burning ongoing pain, shock-like pain)	thermhypoesthesia, pallhypoesthesia
Evoked pain (hyperalgesia, allodynia)	Bothersome, but not painful
	Mechanism: degeneration of a particular fiber system

Table 3.

Possible causes of peripheral neuropathy [21]

Nerve compression (lumbar disc herniation, spinal stenosis, cancer, abscess)

Carpal tunnel syndrome, tarsal tunnel syndrome

Blood vessel insufficiency

Neurotoxic substance (alcohol, cigarette)

Vitamin deficiency particularly B₁₂ and folate

Hypothyroidism

Uremic syndrome

Drugs (vincristine, isoniazid, phenytoin, D-penicillamine)

Transient ischemic attack, cerebrovascular accident

Cancer (paraneoplastic syndrome)

Raynaud's phenomenon

Adapted from the book of Korean Diabetes Association (Diabetic neuropathy management guidebook. 3rd ed.) [21] with original copyright holder's permission.

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