Recent clinical advances in diabetic polyneuropathy.
OBJECTIVE
Recent dramatic increases in the incidence and prevalence of diabetes make an understanding of chronic symmetric sensorimotor diabetic polyneuropathy, the most common and problematic of chronic diabetic complications, essential for a wide range of medical practitioners.


RESULTS
The demonstration of neuropathic dysfunction in patients with prediabetes or impaired glucose tolerance emphasizes the susceptibility of peripheral nerve fibers, especially small A delta fibers and C fibers, to relatively mild, short-duration hyperglycemia. New testing can reveal peripheral nerve dysfunction prior to clinical neuropathic symptoms and signs. In the absence of effective medications to halt or reverse nerve damage or promote nerve regeneration, early diagnosis of diabetic polyneuropathy, followed by tight glycemic control with diet and exercise, offers the best opportunity to prevent progressive symptoms of sensory loss, pain, autonomic dysfunction, ulcerations, and amputations. Some patients with impaired glucose tolerance have a reversal of neuropathic features with tight glycemic control. Nonpharmacologic therapies for neuropathic pain in diabetic polyneuropathy appear promising.


CONCLUSIONS
Tight glycemic control, especially early in diabetes, is the best approach to minimizing the prevalence and severity of diabetic polyneuropathy and makes research into the deleterious effects of even mild hyperglycemia imperative.
Horowitz
Steven H
SH
Department of Neurology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. shhorowitz@partners.org
D000700:Analgesics / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D002986:Clinical Trials as Topic; D019299:Decompression, Surgical; D003929:Diabetic Neuropathies / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004599:Electric Stimulation Therapy; D018149:Glucose Intolerance / Q000150:complications; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D018908:Muscle Weakness / Q000209:etiology / Q000628:therapy; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D059408:Pain Management; D010147:Pain Measurement
D000700:Analgesics; D001786:Blood Glucose; D007004:Hypoglycemic Agents