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my personal edition > geriatrics > news
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DGReview
Effective Treatments Available for Diagnosed Diabetic Neuropathy
A DGReview of :"Diabetic polyneuropathy: Risk factors, patterns of presentation, diagnosis, and treatment "
Geriatrics
07/03/2003
By Deanna M Green
Although a cure is not yet available for diabetic neuropathy, intensive glucose control and pain management are the most effective treatments for slowing disease progression and improving quality of life.
Diabetic symmetrical distal neuropathy is a common complication of diabetes mellitus. Patients with diabetic neuropathy often experience related complications, such as pain, ambulation difficulties, and risk of amputation.
Proper recognition and awareness of the disease patterns and risk factors for diabetic neuropathy are vital in order for physicians to make an accurate diagnosis and recommend appropriate treatment options.
Ann Noelle Poncelet, MD, from the University of California, San Francisco, United States, reviewed the risk factors, presentation patterns, diagnosis and treatment of diabetic polyneuropathy.
Patients with diabetic polyneuropathy typically experience functional disabilities, such as impaired gait and impaired fine finger movements, as well as autonomic symptoms, including abnormal sweating, heart rate abnormalities, impotence, and diarrhoea or constipation.
Characteristic symptoms of neuropathic pain include burning, shooting or lancinating pain, allodynia pain, paresthesias pain and hyperaesthesia pain, aching, cramping, and nocturnal exacerbation.
Early diagnosis of diabetic polyneuropathy is crucial in order to prevent chronic ulcers, amputation and other related complications.
Diagnosis is typically made from analysing the clinical history of the patients and testing for distal symmetrical sensory and motor neuropathy. Other available diagnostic tests include EMG/nerve conduction studies and laboratory studies that are used to exclude treatable causes of neuropathy.
Physicians should also be aware of signs of non-diabetic neuropathy which can be treated. These include neuropathy which develops prior to or early in the course of the diabetes, neuropathy occurring in controlled diabetes, asymmetrical involvement, and significant proximal involvement or upper extremity involvement.
Currently, the only proven therapy for diabetic polyneuropathy is intensive glucose control. This type of management has been shown to reduce the incidence and slow the progression of the disease.
In addition, treatment for symptoms of neuropathic pain can greatly improve the quality of life of patients with diabetic polyneuropathy. Pain management and podiatric care can aid in the prevention of chronic ulcerations and relieve intense pain.
Dr. Poncelet emphasizes that "diabetic patients need an annual neurologic and clinical evaluation of the foot," as recommended by the American Diabetes Association. Furthermore, she notes that "there is no cure for diabetic neuropathy, but it is treatable," particularly with early diagnosis.
Geriatrics 2003;58:6:16-30.
"Diabetic polyneuropathy: Risk factors, patterns of presentation, diagnosis, and treatment "
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