[Diabetic neuropathy: vascular disease?].
BACKGROUND
The major neurologic complications of diabetes are: 1) Neuropathy, both peripheral and autonomic, with principal manifestations in the lower limbs; 2) Microvascular disease, mainly affecting the retina, resulting in blindness; and 3) Macrovascular disease, presenting with atherosclerosis in the cerebral arteries causing ischemic cerebrovascular disease and stroke.


METHODS
The definition of diabetic neuropathy has changed over the last 50 years. Over the last 20 years there have been three main pathogenetic theories to explain diabetic neuropathy: the polyol pathway theory, the microvascular theory, and the glycosylation end product theory. It is apparent that several pathophysiologic factors probably operate simultaneously, and it may be too simplistic to attempt to explain the many clinical and pathologic findings of diabetic neuropathy through a single theory. Diabetic peripheral neuropathy is not caused by large vessel peripheral vascular disease, however, it does appear that small vessel disease plays a role.


CONCLUSIONS
It seems likely, that microangiopathy on the one hand and changes of various metabolic pathways due to hyperglycemia on the other hand are much more related to each other than it was suggested previously.
Otero-Siliceo
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Neurología, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suarez, México DF, México. dr_enriqueotero@yahoo.com
Ruano-Calderón
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LA
D001808:Blood Vessels / Q000473:pathology; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000473:pathology / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000473:pathology / Q000503:physiopathology*; D017127:Glycation End Products, Advanced / Q000378:metabolism; D006801:Humans; D011108:Polymers / Q000378:metabolism; D014652:Vascular Diseases / Q000473:pathology / Q000503:physiopathology*
D017127:Glycation End Products, Advanced; D011108:Polymers; C024617:polyol