Acute painful diabetic neuropathy: an uncommon, remittent type of acute distal small fibre neuropathy.
BACKGROUND
Acute painful diabetic neuropathy (APDN) is a distinctive diabetic polyneuropathy and consists of two subtypes: treatment-induced neuropathy (TIN) and diabetic neuropathic cachexia (DNC). The characteristics of APDN are (1.) the small-fibre involvement, (2.) occurrence paradoxically after short-term achievement of good glycaemia control, (3.) intense pain sensation and (4.) eventual recovery. In the face of current recommendations to achieve quickly glycaemic targets, it appears necessary to recognise and understand this neuropathy.


RESULTS
Over 2009 to 2012, we reported four cases of APDN. Four patients (three males and one female) were identified and had a mean age at onset of TIN of 47.7 years (±6.99 years). Mean baseline HbA1c was 14.2% (±1.42) and 7.0% (±3.60) after treatment. Mean estimated time to correct HbA1c was 4.5 months (±3.82 months). Three patients presented with a mean time to symptom resolution of 12.7 months (±1.15 months). One patient had an initial normal electroneuromyogram (ENMG) despite the presence of neuropathic symptoms, and a second abnormal ENMG showing axonal and myelin neuropathy. One patient had a peroneal nerve biopsy showing loss of large myelinated fibres as well as unmyelinated fibres, and signs of microangiopathy.


CONCLUSIONS
According to the current recommendations of promptly achieving glycaemic targets, it appears necessary to recognise and understand this neuropathy. Based on our observations and data from the literature we propose an algorithmic approach for differential diagnosis and therapeutic management of APDN patients.
Service of Endocrinology, Diabetes and Metabolism, Lausanne University Hospital (CHUV), Switzerland; Centre for Molecular Diseases, Lausanne University Hospital (CHUV), Switzerland.
Christel
C
Tran
Division of Endocrinology, Diabetology, Hypertension and Nutrition, Geneva University Hospital, Switzerland.
Jacques
J
Philippe
Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Switzerland.
François
F
Ochsner
Nerve-Muscle Unit, Department of Clinical Neurosciences, Lausanne University Hospital (CHUV), Switzerland.
Thierry
T
Kuntzer
Department of Neurology, Geneva University Hospital, Switzerland.
André
A
Truffert
D059787:Acute Pain / Q000209:etiology*; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003929:Diabetic Neuropathies / Q000209:etiology*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D009412:Nerve Fibers / Q000502:physiology; D012867:Skin / Q000294:innervation
D001786:Blood Glucose; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human