The Effect of Intensive Diabetes Therapy on the Development and Progression of Neuropathy

  title={The Effect of Intensive Diabetes Therapy on the Development and Progression of Neuropathy},
  journal={Annals of Internal Medicine},
  • Published 1995
  • Medicine
  • Annals of Internal Medicine
For many patients, diabetes mellitus would be little more than a troublesome but manageable metabolic disorder were it not for its devastating late complications. Diabetes mellitus is the leading cause of peripheral neuropathy in developed nations. Peripheral neuropathy affects at least 15% of all persons with diabetes [1] and 37% of persons 18 years and older with insulin-dependent diabetes mellitus. The prevalence of neuropathy depends on the specific definition used [2]. The hallmark of… 
Diabetic Neuropathy
While disease-altering therapy continues to prove elusive, the understanding of basic disease mechanisms is improving, and new diagnostic and research tools will hopefully lead to novel therapies for distal symmetric diabetic polyneuropathy.
Approach to diabetic neuropathy
Early treatment of diabetic neuropathy should include tight glycemic control, and an annual comprehensive foot examination is a must for all patients with diabetes to help in identification of risk factor predictive of ulcers and amputation.
The presence of inflammatory infiltrates in nerves of diabetic patients supports an autoimmune process, and the role of neurotrophic factors is supported by the observation that NGFassociated small diameter sensory fibres are affected before involvement of the other fibre types.
Diagnosis and Management of Diabetic Peripheral Neuropathy
  • D. Ziegler
  • Medicine, Psychology
    Diabetic medicine : a journal of the British Diabetic Association
  • 1996
This review will focus only on the distal symmetrical sensory or sensorimotor polyneuropathy which represents the most important clinical manifestation of diabetic neuropathy.
Diagnosis and treatment of the early stages of diabetic polyneuropathy
Prevalence, diagnostic approaches and potential treatment options for early diabetic polyneuropathy are reviewed and the correlation between the severity of oxidative stress and the activity of antioxidant defense is considered as a potential mechanism for early nerves damage with hyperglycemia.
Diabetic neuropathy
Management of DN includes control of hyperglycaemia, other cardiovascular risk factors; α lipoic acid and L carnitine, and treatment of autonomic neuropathy is symptomatic.
Diabetic neuropathies: clinical manifestations and current treatment options
Diabetic neuropathies are a heterogeneous group of disorders that include a wide range of abnormalities, affecting both peripheral and autonomic nervous systems, causing morbidity with significant impact on the quality of life of the person with diabetes, and can result in early death.
Management of Diabetic Peripheral Neuropathy
Routine management consists of glucose and risk factor control, and symptomatic relief, along with therapies designed to target the underlying disease pathology, and pharmacological treatment includes tricyclic compounds, serotonin noradrenalin reuptake inhibitors, the antioxidant α-lipoic acid, anticonvulsants, opiates, membrane stabilizers, topical capsaicin, and other drugs.
Treating Diabetic Neuropathy: Present Strategies and Emerging Solutions.
Optimal glucose control represents the only broadly accepted therapeutic option though evidence of its benefit in type 2 diabetes is unclear and there is a growing need for head-to-head studies of different single-drug and combination pharmacotherapies.
Polyneuropathy in type 1 and type 2 diabetes: do we need different examinations?
The examinations of Løseth et al. included nerve conduction studies for detection of large fibre involvement as well as quantitative sensory testing for differences in phenotypic characteristics between patients with type 1 and 2 diabetes.


Complications: Neuropathy, Pathogenetic Considerations
Although major questions about the pathogenesis of diabetic neuropathy remain unanswered and require further intense investigation, significant recent progress is pushing us into the future and likely constitutes only the first of many therapies directed against one or more elements of the complex pathogenetic process responsible for diabetic Neuropathy.
Epidemiological Correlates of Diabetic Neuropathy: Report From Pittsburgh Epidemiology of Diabetes Complications Study
Traditional cardiovascular risk factors (e.g., lipids and smoking) are important determinants of distal symmetric polyneuropathy and if confirmed in prospective follow-up, open new avenues to the prevention of diabetic neuropathy.
Meaningful Degrees of Prevention or Improvement of Nerve Conduction in Controlled Clinical Trials of Diabetic Neuropathy
It is suggested that in controlled clinical trials, a mean change of 2 points on the neurologic disability score is clinically detectable and meaningful.
The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long‐Term Complications in Insulin‐Dependent Diabetes Mellitus
Intensive therapy effectively delays the onset and slows the progression of diabetic retinopathy, nephropathy, and neuropathy in patients with IDDM.
The effect of long-term intensified insulin treatment on the development of microvascular complications of diabetes mellitus.
Long-term intensified insulin treatment, as compared with standard treatment, retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus.
Effects of age, sex, and anthropometric factors on nerve conduction measures
Associations among measures of median, ulnar, and sural nerve conduction and age, skin temperature, sex, and anthropometric factors were evaluated in a population of 105 healthy, asymptomatic adults
Diabetes Mellitus and Its Degenerative Complications: A Prospective Study of 4,400 Patients Observed Between 1947 and 1973
This article was originally published in French in Diabete et Metabolisme (vol. 3: 97–107, 173–182, 245–256; 1977) and is being translated by Marjorie Levin of Miami, Florida.
Assessment of Cardiovascular Autonomic Function: Age‐related Normal Ranges and Reproducibility of Spectral Analysis, Vector Analysis, and Standard Tests of Heart Rate Variation and Blood Pressure Responses
All indices of spectral and vector analyses of HRV are age‐dependent and have the advantage of being independent of heart rate, and RMSSD, E‐I difference, and the 30:15 ratio are not suitable for evaluation of autonomic dysfunction in diabetes.
Some large-sample distribution-free estimators and tests for multivariate partially incomplete data from two populations.
  • J. Lachin
  • Mathematics
    Statistics in medicine
  • 1992
Alternative K and 1 d.f. distribution-free procedures which allow for randomly missing observations are described, and an analysis of repeated cholesterol measurements in two groups of patients, stratified by sex is illustrated.