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Spectrum of diabetic neuropathies

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Abstract

The diabetic state results in neuropathy. The main causative mechanism is hyperglycemia, although microvascular involvement, hypertriglyceridemia, as well as genetic and immune mechanisms may be contributory. There is a growing spectrum of types of diabetic neuropathies that differ based on the type of fibers involved (e.g. myelinated, unmyelinated, autonomic, somatic), distribution of nerves involved, and mechanisms of neuropathy. The most common type is distal sensory neuropathy (DSN), which affects the distal ends of large myelinated fibers, more often sensory than motor, and is often asymptomatic. The next-most common is distal small fiber neuropathy (DSFN), which largely affects the unmyelinated fibers and carries the phenotype of burning feet syndrome. Diabetic autonomic neuropathy (DAN) occurs when widespread involvement of autonomic unmyelinated fibers occurs, and patients can be incapacitated with orthostatic hypotension as well as neurogenic bladder and bowel involvement. Radiculoplexus diabetic neuropathy causes proximal weakness and pain, usually in the lower extremity, and has a combination of immune, inflammatory, and vascular mechanisms. The nerve roots and plexus are involved. These patients present with proximal weakness of a subacute onset, often with severe pain and some autonomic failure. Finally, rapid and sustained reduction of blood glucose can result in treatment-induced diabetic neuropathy (TIND), which largely affects the sensory and autonomic fibers. This occurs if HbA1c is rapidly reduced within 3 months, and the likelihood is proportional to the original A1c and the size of the reduction.

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Acknowledgements

This work was supported in part by the National Institutes of Health (NS 32352 Autonomic Disorders Program Project, NS 44233 Pathogenesis and Diagnosis of Multiple System Atrophy, NS 92625 Multiple System Atrophy–Novel Targets in Early Diagnosis, Pathophysiology, and Therapeutic Approach, U54 NS065736 Autonomic Rare Disease Clinical Consortium, K23NS075141 Differential Approach to the Postural Tachycardia Syndrome (Singer), FDA (FD004789), The Cure MSA Foundation, Mayo CTSA (UL1 TR000135), and Mayo Funds. The Autonomic Diseases Consortium is a part of the NIH Rare Diseases Clinical Research Network (RDCRN). Funding and/or programmatic support for this project was provided by U54 NS065736 from the National Institute of Neurological Diseases and Stroke (NINDS) and the NIH Office of Rare Diseases Research (ORDR). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health.

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  1. Wakayama Medical University, Wakayama, Japan

    Hideyuki Sasaki

  2. Kawamura Hospital, Gifu, Japan

    Nobutoshi Kawamura

  3. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Peter J. Dyck, P. James B. Dyck & Phillip A. Low

  4. Hidaka Hospital, Takasaki, Japan

    Mikihiro Kihara

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Sasaki, H., Kawamura, N., Dyck, P.J. et al. Spectrum of diabetic neuropathies. Diabetol Int 11, 87–96 (2020). https://doi.org/10.1007/s13340-019-00424-7

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