title: Physiology in Medicine: neuromuscular consequences of diabetic neuropathy.
abstract: Diabetic polyneuropathy (DPN) refers to peripheral nerve dysfunction as a complication of diabetes mellitus. This condition is relatively common and is likely a result of vascular and/or metabolic disturbances related to diabetes. In the early or less severe stages of DPN it typically results in sensory impairments but can eventually lead to major dysfunction of the neuromuscular system. Some of these impairments may include muscle atrophy and weakness, slowing of muscle contraction, and loss of power and endurance. Combined with sensory deficits these changes in the motor system can contribute to decreased functional capacity, impaired mobility, altered gait, and increased fall risk. There is no pharmacological disease-modifying therapy available for DPN and the mainstay of treatment is linked to treating the diabetes itself and revolves around strict glycemic control. Exercise therapy (including aerobic, strength, or balance training-based exercise) appears to be a promising preventative and treatment strategy for patients with DPN and those at risk. The goal of this Physiology in Medicine article is to highlight important and overlooked dysfunction of the neuromuscular system as a result of DPN with an emphasis on the physiologic basis for that dysfunction. Additionally, we sought to provide information that clinicians can use when following patients with diabetes or DPN including support for the inclusion of exercise-based therapy as an effective, accessible, and inexpensive form of treatment.
authors.affiliation: School of Medicine, Queen's University, Kingston, Ontario, Canada; School of Kinesiology and Health Studies, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada; School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada; kkimpin@uwo.ca.
authors.forename: Matti D
authors.identifier: 0000-0002-0755-3164
authors.initials: MD
authors.lastname: Allen
authors.affiliation: School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada; Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada; and.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Doherty
authors.affiliation: School of Kinesiology, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada; Department of Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada.
authors.forename: Charles L
authors.initials: CL
authors.lastname: Rice
authors.affiliation: Department of Clinical Neurological Sciences, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada;
authors.forename: Kurt
authors.initials: K
authors.lastname: Kimpinski
mesh_terms: D003929:Diabetic Neuropathies / Q000150:complications* / Q000503:physiopathology*; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D009119:Muscle Contraction / Q000502:physiology; D018482:Muscle, Skeletal / Q000503:physiopathology*; D009468:Neuromuscular Diseases / Q000209:etiology* / Q000503:physiopathology*
keywords: diabetes; exercise; fatigue; muscle; weakness