Skip to main content
SpringerLink
Log in

Diabetische Neuropathie

Diabetic neuropathy

  • leitlinien für die praxis
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Der Begriff der diabetischen Neuropathie umfasst Mono- und Polyneuropathieformen, die diabetische Plexopathie, Radikulopathie und die autonome Neuropathie. Die Leitlinienempfehlungen beschreiben die klinischen Symptome und diagnostischen Möglichkeiten sowie die Therapiemaßnahmen, insbesondere bei der schmerzhaften Form der sensomotorischen Neuropathie.

Summary

These are the guidelines for diagnosis and treatment of diabetic neuropathy. This diabetic late complication comprises a number of mono- and polyneuropathies, plexopathies, radiculopathies and autonomic neuropathy. The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abbott CA, Malik RA, van Ross ER, Kulkarni J, Boultin AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34:2220–4.

    Article  PubMed  PubMed Central  Google Scholar 

  2. ADVANCE Collaborative Group. Intensive blood glucose control and vascular outcome in patients with type 2 diabetes. N Engl J Med. 2008;358:2560–72.

    Article  Google Scholar 

  3. American Diabetes Association. Microvascular complications and foot care. Diabetes Care. 2015;38(Suppl 1):S58–66.

    Article  Google Scholar 

  4. Amthor KF, Dahl-Jorgensen K, Berg TJ, et al. The effect of 8 years of strict glycaemic control on peripheral nerve function in IDDM patients. The Oslo study. Diabetologia. 1994;37:579–84.

    Article  CAS  PubMed  Google Scholar 

  5. Bolton CF, Remtulla H, Toth B, Bernardi L, Lindsay RM, Maryniak O, Burton SR. Distinctive electrophysiological features of denervated muscle in uremic patients. J Clin Neurophysiol. 1997;14:539–42.

    Article  CAS  PubMed  Google Scholar 

  6. Bril V, England JD, Franklin GM, Backonja M, Cohen JA, Del Toro DR, Feldman EL, Iverson DJ, Perkins B, Russell JW, Zochodne DW. Evidence-based guideline: treatment of painful diabetic neuropathy – report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation. Muscle Nerve. 2011;43:910–17.

    Article  PubMed  Google Scholar 

  7. Callaghan BC, Cheng HAT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatment. Lancet Neurol. 2012;11:521–34.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29:1518–22.

    Article  PubMed  Google Scholar 

  9. Diabetes Control and Complication Trial Research Group. The effects of intensive treatment of diabetes on the developmentand progressive of long term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993;329:977–86.

    Article  Google Scholar 

  10. Doupis J, Lyons TE, Wu S, Gnardellis C, Dinh T, Veves A. Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy. J Clin Endocrinol Metab. 2009;94:2157–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Duckworth W, Abraira C, Moritz T, et al. Intensive glucose control and complications in American Veterans with type 2 diabetes. N Engl J Med. 2009;8:129–39.

    Article  Google Scholar 

  12. Dyck PJ, Karnes JL, O’Brien PC, et al. The Rochester diabetic neuropathy study: reassessment of tests and criteria for diagnosis and staged severity. Neurology. 1992;42:1164–70.

    Article  CAS  PubMed  Google Scholar 

  13. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy and nephropathy in a population-based cohort: the Rochester diabetic neuropathy study. Neurology. 1993;43:817–24.

    Article  CAS  PubMed  Google Scholar 

  14. Feldman EL. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17:1281–9.

    Article  CAS  PubMed  Google Scholar 

  15. Gremizzi C, Vergani A, Paloschi V, Secchi A. Impact of pancreas transplantation on type 1 diabetes-related complications. Curr Opin Organ Transplant. 2010;15:119–23.

    Article  PubMed  Google Scholar 

  16. Guastella V, Mick G. Strategies for the diagnosis and treatment of neuropathic pain secondary to diabetic peripheral sensory polyneuropathy. Diabetes Metab. 2009;35:12–9.

    Article  CAS  PubMed  Google Scholar 

  17. Hoeldike RD, Bryner KD, Van Dyke K. Oxidative stress and autonomic nerve function in early type 1 diabetes. Clin Auton Res. 2011;21:19–28.

    Article  Google Scholar 

  18. Holman RR, Paul SK, Bethal MA, et al. 10-years follow-up of intensive glucose control in type 2 diabetes. N Engl J Med. 2008;359:1577–84.

    Article  CAS  PubMed  Google Scholar 

  19. Lauria G, Hsieh ST, Johansson O, Kennedy WR, Leger JM, Mellgren SI, Nolano M, Merkies ISJ, Polydefkis M, Smith AG, Sommer C, Valls-Solé J. European Federation of Neurological Societies/Peripheral Nerve Society Guideline on the use of skin biopsy in the diagnosis of small fiber neuropathy. Report of a joint task force of the European Federation of Neurological Societies and the Peripheral Nerve Society. Eur J Neurol. 2010;17:903–e49.

    Article  CAS  PubMed  Google Scholar 

  20. Malik RA, Kallinikos P, Abbott CA, van Schie CH, Morgan P, Efron N, Boulton AJ. Corneal confocal microscopy: a non-invasive surrogate of nerve fibre damage and repair in diabetic patients. Diabetologia. 2003;46:683–8.

    CAS  PubMed  Google Scholar 

  21. Martin CL, Albers J, Herman WH, et al. Neuropathy among the diabetes control and complications trial cohort 8 years after trial. Diabetes Care. 2006;29:340–4.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Maser RE, Steenkiste AR, Dorman JS, et al. Epidemiological correlates of diabetic neuropathy. Report from Pittsburgh epidemiology of diabetes complication study. Diabetes. 1989;38:1456–61.

    Article  CAS  PubMed  Google Scholar 

  23. McIlduff CE, Rutkove SB. Critical appraisal of the use of alpha lipoic acid (thioctic acid) in the treatment of symptomatic diabetic polyneuropathy. Ther Clin Risk Manag. 2011;7:377–85.

    CAS  PubMed  PubMed Central  Google Scholar 

  24. Meijer JW, Bosma E, Leprandt JD, Links TP, Smit AJ, Stewart RE, Van Der Hoeven JH, Hoogenberg K. Clinical diagnosis of diabetic polyneuropathy with the diabetic neuropathy symptoms and diabetic neuropathy examination score. Diabetes Care. 2003;26:697–701.

    Article  PubMed  Google Scholar 

  25. Moore RA, Straube S, Wiffen PJ, Derry S, McQuay HJ. Pregabalin for acute and chronic pain in adults. Cochrane Database Syst Rev. 2009;8:CD007076.

    Google Scholar 

  26. Mueller MJ. Identifying patients with diabetes mellitus who are at risk for lower-extremity complications: use of Semmes- Weinstein monofilaments. Phys Ther. 1996;76:68–71.

    CAS  PubMed  Google Scholar 

  27. Papanas N, Paschos P, Papazoglu D, Papatheodorou K, Paletas K, Maltezos E, Tsapas A. Accuracy of the Neuropad test for the diagnosis of distal symmetric polyneuropathy in type 2 diabetes. Diabetes Care. 2011;34:1378–82.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Rahman M, Griffin SJ, Rathman W, Wareham NJ. How should peripheral neuropathy be assessed in people with diabetes in primary care? A population-bases comparison of four measures. Diabet Med. 2003;20:368–74.

    Article  CAS  PubMed  Google Scholar 

  29. Reichard P, Pihl M, Rosenqvist U, Sule J. Complications in IDDM are caused by elevated blood glucose levels:the Stockholm Diabetes Intervention Study (SDIS) at 10-years follow up. Diabetologia. 1996;31:1483–8.

    Article  Google Scholar 

  30. Sima AA, Sugimoto K. Experimental diabetic neuropathy. An update. Diabetologia. 1999;42:773–88.

    Article  CAS  PubMed  Google Scholar 

  31. Snedcor SJ, Sudharshan L, Cappelleri JC, Sadosky A, Mehta S, Botteman M. Systematic review and meta-analysis of pharmacological therapies for painful diabetic peripheral neuropathy. Pain Pract. 2014;14:167–84.

    Article  Google Scholar 

  32. Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic neuropathy. Diabetes Metab Res Rev. 2012;28 Suppl 1:8–14.

    Article  PubMed  Google Scholar 

  33. Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, Lauria G, Malik RA, Spallone V, Vinik A, Bernardi L, Valensi P. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33:2285–93.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Tesfaye S, Vileikyte L, Rayman G, et al. On behalf of The Toronto Expert Panel on Diabetic Neuropathy. Diabetes Metab Res Rev. 2011;27:629–38.

    Article  CAS  PubMed  Google Scholar 

  35. UK Prospective Diabetes (UKPDS) Group. Intensive blood-glucose control with sulfonylureas or insulin compared with conventional treatment and rate of complication in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;12:837–63.

    Google Scholar 

  36. Van de Pollyranse LV, Valk GD, Renders CM, Heine RJ, Eijk JTM. Longitudinal assessment of the development of diabetic polyneuropathies and associated risk factors. Diabetic Med. 2003;19:771–9.

    Google Scholar 

  37. Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanism as therapeutic targets. Nat Rev Neurol. 2011;7:573–83.

    Article  CAS  PubMed  Google Scholar 

  38. Vinik AI, Maser RE, Mitchell BD, Freema R. Diabetic autonomic neuropathy. Diabetes Care. 2003;26:1553–79.

    Article  PubMed  Google Scholar 

  39. Yagihashi S, Yamagishi SI, Wada RI, et al. Neuropathy in diabetic mice overexpressing human aldose reductase and effects of aldose reductase inhibitor. Brain. 2001;124:2448–58.

    Article  CAS  PubMed  Google Scholar 

  40. Young MJ, Boulton AJM, MacIEOD, et al. A multicenter study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital population. Diabetologia. 1993;36:150–4.

    Article  CAS  PubMed  Google Scholar 

  41. Ziegler D. Treatment of diabetic neuropathy: update 2006. Ann N Y Acad Sci. 2006;1084:250–68.

    Article  CAS  PubMed  Google Scholar 

  42. Ziegler D. Treatment of diabetic neuropathy and neuropathic pain. Diabetes Care. 2008;31 Suppl 2:255–61.

    Article  Google Scholar 

  43. Ziegler D. Diagnosis and treatment of diabetic autonomic neuropathy. Curr Diab Rep. 2011;3:216–27.

    Google Scholar 

  44. Ziegler D, Fonseca V. From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy. J Diabetes Complications. 2015;29:146–56.

    Article  PubMed  Google Scholar 

  45. Ziegler D, Gries FA. Epidemiologie der peripheren diabetischen Neuropathie. Diabetes Stoffwechs. 1992;1:24–8.

    Google Scholar 

  46. Ziegler D, Rathmann W, Dickhaus T, Meisinger C, Mielck. KORA study group: neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Survey S2 and S3. Pain Med. 2009;10:393–400.

    Article  PubMed  Google Scholar 

  47. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with alpha-lipoic acid over 4 years in diabetic polyneuropathy: the Nathan 1 trial. Diabetes Care. 2011;34:2054–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  48. Zochodne DW. Diabetes mellitus and the peripheral nervous system: manifestations and mechanisms. Muscle Nerve. 2007;36:144–66.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Interne Abteilung, Landeskrankenhaus Hochzirl - Natters, Hochzirl, Österreich

    Monika Lechleitner

  2. Internistisches Zentrum, Sozialmedizinisches Zentrum Baumgartner Höhe, Otto-Wagner-Spital, Wien, Österreich

    Heidemarie Abrahamian

  3. Sonderkrankenanstalt Rehabilitationszentrum Alland, Alland, Österreich

    Claudia Francesconi

  4. Abteilung für Neurologie, Landeskrankenhaus Hochzirl, Hochzirl, Österreich

    Markus Kofler

Authors
  1. Monika Lechleitner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heidemarie Abrahamian
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Claudia Francesconi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Markus Kofler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Monika Lechleitner.

Ethics declarations

Interessenkonflikt

M. Lechleitner hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Honorare erhalten: AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline Pharma, Eli Lilly, Merck Sharp & Dome, Novartis, Novo Nordisk, Pfizer, sanofi-sventis, Takeda.

H. Abrahamian hat von folgenden Unternehmen, die auch fördernde Mitglieder der ÖDG sind, Forschungsunterstützungen und/oder Honorare erhalten: Abbott, Bristol-Myers Squibb, Germania Pharmazeutika, Eli Lilly, Merck Sharp & Dohme, Novo Nordisk, sanofi-aventis, Takeda.

C. Francesconi und M. Kofler haben keinen Interessenkonflikt.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Lechleitner, M., Abrahamian, H., Francesconi, C. et al. Diabetische Neuropathie. Wien Klin Wochenschr 128 (Suppl 2), 73–79 (2016). https://doi.org/10.1007/s00508-015-0930-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-015-0930-4

Schlüsselwörter

Keywords

Search

Navigation