Edit concept Question Editor Create issue ticket

Diabetic Polyneuropathy

Polyneuropathy in Diabetes


Presentation

  • Abstract Diabetic polyneuropathy (DPN) has several forms of clinical presentation. It may be asymptomatic, or present with prominent sensory symptoms, including neuropathic pain.[ncbi.nlm.nih.gov]
  • Plantar ulcers and neurogenic arthropathies were also present in 3 patients.[ncbi.nlm.nih.gov]
  • Abstract The aim of this paper is to present to new method for assessment diabetic polyneuropathy, before the moment of first clinical sign.[ncbi.nlm.nih.gov]
  • Abstract We present 4 patients who had a subacute, predominantly motor polyneuropathy associated with diabetes mellitus and end-stage renal disease.[ncbi.nlm.nih.gov]
  • Abstract A 70-year-old diabetic woman with sensory polyneuropathy presented with osteonecrosis of the toes and a plaque-like lesion on the dorsum of the ipsilateral foot. Histological diagnosis of eccrine syringofibroadenoma (ES) was made.[ncbi.nlm.nih.gov]
Burning Feet
  • The first signs and symptom are hypoalgesia, burning feet particularly during the night increasing with touch, and paraesthesia of the feet. Paroxysmal shooting pains also occur.[pijn.com]
  • For sensory neuropathy: Numbness or tingling in the feet Pain or discomfort in the feet or legs, including prickly, sharp pain or burning feet For motor neuropathy: Muscle weakness and loss of muscle tone in the feet and lower legs Loss of balance Changes[foothealthfacts.org]
  • Besides that, patients with burning feet due to small fiber neuropathy are not expected to have abnormalities in nerve conduction studies.[scielo.br]
  • One individual, who reported burning feet at night, slept with her feet uncovered and a fan blowing cool air on them.[nfb.org]
Progressive Polyneuropathy
Numbness of the Feet
  • The primary outcome measure was the change from baseline of the Total Symptom Score (TSS), including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet.[drperlmutter.com]
  • Symptoms can range from pain and numbness in your feet to problems with the functions of your internal organs, such as your heart and bladder. What Is Diabetic Neuropathy? Diabetic neuropathy is nerve damage that is caused by diabetes.[niddk.nih.gov]
  • Peripheral neuropathy most commonly causes : pain , burning, tingling, and numbness of the feet and lower legs.[medicinenet.com]
  • In general, symptoms may include: Reduced feeling or numbness in the feet. Over time, tightness, burning, shooting, or stabbing pain in the feet, hands, or other parts of the body.[healthlinkbc.ca]
Myofascial Trigger Point
  • Joint dysfunction was detected in the mortise and intertarsal joints and myofascial trigger points were found in the quadratus plantae muscles.[ncbi.nlm.nih.gov]
Dysesthesia
  • Abstract Patients with diabetes occasionally develop diabetic polyneuropathy (DPN), which is characterized by both positive symptoms such as pain and negative symptoms such as numbness/dysesthesia.[ncbi.nlm.nih.gov]
  • Its symptoms are paresthesia, dysesthesia and pain. The signs of damage to the peripheral neurons are hypoesthesia, hypoalgesia, hyperesthesia and hyperalgesia, decreased tendon reflexes, and, possibly, weakness and muscle atrophy.[ncbi.nlm.nih.gov]
  • Author information 1 Department of Neurology, The Johns Hopkins Hospital, Baltimore, MD 21287, USA. mpolyde@jhmi.edu Abstract Patients with complaints of numbness, tingling, and dysesthesias in the toes and feet are frequently referred to neurologists[ncbi.nlm.nih.gov]
  • […] standing up a faster heart rate than normal excessive sweating, even in cool temperatures or while at rest bladder problems, for example, difficulty emptying the bladder completely when urinating, leading to incontinence sexual dysfunction in men and women dysesthesia[medicalnewstoday.com]
Decreased Ankle Reflex
  • Clinically, contrasting loss of sharp touch and temperature with subjective increased pain is common. 1,2, 7,9,12 Decreased vibration and position sense occur frequently, but are less sensitive. 2, 7,9,12 Decreased ankle reflexes are also common, as well[dynamicchiropractic.com]

Workup

  • The workup is completed by the performance of an electromyogram with nerve conduction studies to quantitate the extent of involvement of the peripheral nervous system. Diabetic neuropathy, unfortunately, has no effective treatment at this point.[bcm.edu]
Neurophysiologic Abnormalities
  • Normal deviate (from percentiles) composite scores of NC included: representative of neurophysiological abnormalities; sensitive and specific for diagnosis and useful for epidemiological surveys; randomized trials; and medical practice.[ncbi.nlm.nih.gov]
Sinus Arrhythmia
  • Statistical regression analyses revealed significant trends in 11 of 17 patients, while no significant differences were observed when comparing autonomic screening by short-term HRV and respiratory sinus arrhythmia at baseline and after the 8 weeks training[ncbi.nlm.nih.gov]

Treatment

  • Preoperative clinical sensory testing did not differentiate between treatment responders from non-responders. CONCLUSIONS: SCS seems to be an efficacious and feasible treatment for intractable PDP.[ncbi.nlm.nih.gov]
  • CPM and OA were measured before and on the last day of treatment. RESULTS: Before treatment, none of the patients had significant CPM or OA responses.[ncbi.nlm.nih.gov]
  • Several pathogenetic treatment approaches have been investigated, but evidence from clinical trials is limited with a number of treatments having shown disappointing results.[ncbi.nlm.nih.gov]
  • RESULTS: Change in primary end point from baseline to 4 years showed no significant difference between treatment groups (P 0.105).[ncbi.nlm.nih.gov]
  • Novel compounds should be developed for the treatment of PDPN.[ncbi.nlm.nih.gov]

Prognosis

  • AIMS/HYPOTHESIS: Early diagnosis of diabetic polyneuropathy (DPN) is critical for a good prognosis.[ncbi.nlm.nih.gov]
  • The prognosis for diabetic neuropathy is based on the type of neuropathy. As discussed in an earlier question, there are several type of diabetic neuropathy and listed below is the prognosis of each.[sharecare.com]
  • Prognosis for Diabetics with Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled.[agingcare.com]
  • When the velocity of the fastest conducting fibers is maintained, the prognosis is favorable. Neurological impairment is less likely in this instance.[dynamicchiropractic.com]
  • Prognosis of Diabetic Neuropathy The prognosis for diabetic neuropathy depends largely on how well the underlying condition of diabetes is handled. Treating diabetes may halt progression and improve symptoms of the neuropathy, but recovery is slow.[myvmc.com]

Etiology

  • Treatment should be directed to improve etiologic factors besides reducing symptoms; several approaches have been evaluated to reduce neuropathic impairments and improve nerve conduction, such as oral antidiabetics, statins, and antioxidants (alpha-lipoic[ncbi.nlm.nih.gov]
  • Antioxidants are considered to be the only etiologic management for diabetic polyneuropathy, and statins such as rosuvastatin increase nitric oxide bioavailability and reduce lipid peroxidation.[dovepress.com]
  • Additionally, patients can be referred if the diagnosis is unclear or if a different etiology is suspected.[pharmacytimes.com]
  • Proposed vascular etiologies include nerve dysfunction secondary to disease of vasa nervorum, the microvasculature to the nerves.[practicalpainmanagement.com]
  • You can also refer if the diagnosis is unclear or different etiology is suspected.[labblog.uofmhealth.org]

Epidemiology

  • Abstract This chapter outlines: (1) the reasons why epidemiologic surveys and randomized controlled clinical trials (RCTs) of diabetic polyneuropathy (DPN) are difficult and expensive, and often poorly done, (2) primary and secondary neuropathy end points[ncbi.nlm.nih.gov]
  • Normal deviate (from percentiles) composite scores of NC included: representative of neurophysiological abnormalities; sensitive and specific for diagnosis and useful for epidemiological surveys; randomized trials; and medical practice.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: This study provides further epidemiological evidence for obesity as a risk factor for DPN.[ncbi.nlm.nih.gov]
  • Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh Epidemiology of Diabetes Complications Study. Diabetes 1989;38:1456–1461. PubMed CrossRef Google Scholar 5. Ziegler D.[link.springer.com]
  • Abstract Because there are little satisfactory data on change in severity of diabetic polyneuropathy (DP) over time from study of population-based cohorts of diabetic patients in epidemiologic surveys of DP, it is difficult to predict outcome or morbidity[neurology.org]
Sex distribution
Age distribution

Pathophysiology

  • Its pathophysiological mechanism is not completely clarified and major occurrences boil down to the change in neural phenotype and vasa nervorum.[ncbi.nlm.nih.gov]
  • SIGNIFICANCE: DQEMG may be a clinically useful technique in identifying the presence and severity of neuromuscular pathophysiology and tracking disease progression in DPN. Copyright 2013 International Federation of Clinical Neurophysiology.[ncbi.nlm.nih.gov]
  • The associations among HbA1c, glycemic variability, and DPN suggest a linked pathophysiologic mechanism, which may play a crucial role in clinical risk assessments. 2017 American Academy of Neurology.[ncbi.nlm.nih.gov]
  • Abstract Distal symmetric polyneuropathy (DSPN), the most common form of diabetic neuropathy, has a complex pathophysiology and can be a major source of physical and psychologic disability.[ncbi.nlm.nih.gov]
  • Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance.[ncbi.nlm.nih.gov]

Prevention

  • We concentrate on the prevention of the long-term deficits of neuropathy.[ncbi.nlm.nih.gov]
  • INTRODUCTION: Risk assessment for development foot ulcer in diabetics is a key aspect in any plan and program for prevention of non-traumatic amputation of lower extremities.[ncbi.nlm.nih.gov]
  • Optimal diabetes control is generally considered an essential first step in the prevention and management of DSPN. However, glycaemic control alone may be insufficient to prevent the development or progression of DSPN, especially in type 2 diabetes.[ncbi.nlm.nih.gov]
  • CONCLUSIONS: Four-year treatment with ALA in mild-to-moderate DSPN did not influence the primary composite end point but resulted in a clinically meaningful improvement and prevention of progression of neuropathic impairments and was well tolerated.[ncbi.nlm.nih.gov]
  • Abstract Diabetes is a chronic disease that requires continual medical care and patient self-management education in order to prevent acute complications and to reduce the risk of long-term complications.[ncbi.nlm.nih.gov]

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!