Diabetic neuropathy:  one disease or two?
OBJECTIVE
To compare and contrast the evidence for the effect of glucose control on the prevention of neuropathy in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).


RESULTS
In T1DM, multiple clinical trials have demonstrated a large benefit from enhanced glucose control, whereas the benefit in T2DM is much more modest. Epidemiologic and laboratory evidence exists to support factors other than hyperglycemia in the development of neuropathy including obesity, hypertension, dyslipidemia, inflammation, and insulin resistance.


CONCLUSIONS
T1DM neuropathy and T2DM neuropathy are fundamentally different. In T1DM, glucose control has a large effect on the prevention of neuropathy; therefore, future efforts should continue to concentrate on this avenue of treatment. In contrast, in T2DM, glucose control has a small effect on the prevention of neuropathy; as a result, more research is needed to define the underlying mechanisms for the development of neuropathy. Understanding these mechanisms may lead to novel therapeutic approaches to prevent or treat diabetic neuropathy.
Department of Neurology, University of Michigan, Ann Arbor, Michigan, USA.
Brian C
BC
Callaghan
Junguk
J
Hur
Eva L
EL
Feldman
D000818:Animals; D002986:Clinical Trials as Topic; D017281:Cost of Illness; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000188:drug therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy; D003929:Diabetic Neuropathies / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007249:Inflammation / Q000473:pathology; D007333:Insulin Resistance; D050356:Lipid Metabolism / Q000502:physiology; D009626:Terminology as Topic
D007004:Hypoglycemic Agents