Chapter I. Diabetic Peripheral Neuropathy
Rev Diabet Stud,
2015,
12(1-2):48-62 |
DOI 10.1900/RDS.2015.12.48 |
Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015
Nikolaos Papanas1, Dan Ziegler2,3
1Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece
2Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research, Düsseldorf, Germany
3Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
Address correspondence to: Dan Ziegler, MD, FRCPE, Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Auf'm Hennekamp 65, 40225 Düsseldorf, Germany, e-mail: dan.ziegler@ddz.uni-duesseldorf.de
Manuscript submitted April 14, 2015; resubmitted April 27, 2015; accepted May 7, 2015.
Keywords: diabetes, diabetic neuropathy, hyperglycemia, prevalence, prediabetes, risk factors, hypertension
Abstract
Distal symmetric sensorimotor polyneuropathy (DSPN) is the most common neurological manifestation in diabetes. Major risk factors of DSPN include diabetes duration, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. Height, smoking, insulin resistance, hypoinsulinemia, and others represent an additional risk. Importantly, hyperglycemia, hypertension, dyslipidemia, obesity, and smoking are modifiable. Stringent glycemic control has been shown to be effective in type 1, but not to the same extent in type 2 diabetes. Antilipidemic treatment, especially with fenofibrate, and multi-factorial intervention have produced encouraging results, but more experience is necessary. The major comorbidities of DSPN are depression, autonomic neuropathy, peripheral arterial disease, cardiovascular disease, nephropathy, retinopathy, and medial arterial calcification. Knowledge of risk factors and comorbidities has the potential to enrich the therapeutic strategy in clinical practice as part of the overall medical care for patients with neuropathy. This article provides an updated overview of DSPN risk factors and comorbidities.
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