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2014 ; 20
(5 Peripheral Nervous System Disorders
): 1226-40
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Diabetic neuropathies
#MMPMID25299279
Russell JW
; Zilliox LA
Continuum (Minneap Minn)
2014[Oct]; 20
(5 Peripheral Nervous System Disorders
): 1226-40
PMID25299279
show ga
PURPOSE OF REVIEW: This article provides an overview for understanding the
diagnosis, pathogenesis, and management of diabetic neuropathy. RECENT FINDINGS:
New information about the pathogenesis of diabetic neuropathy continues to
emerge, which will lead to identifying new drug targets. It is clear that the
natural history of diabetic neuropathy is changing and the rate of progression is
slowing. This is likely because of a combination of earlier diagnosis, improved
glycemic management, and improved control of related complications such as
hyperlipidemia and hypertension. Early diagnosis is critical, and small fiber
neuropathy or subclinical diabetic neuropathy may be reversed or significantly
improved with appropriate intervention. The American Academy of Neurology
recently published guidelines for the treatment of painful diabetic neuropathy.
SUMMARY: Diabetic neuropathy is common and can present with varied clinical
presentations discussed in this article. Although treatment currently focuses on
pain management, attention should be paid to potential risk factors for
neuropathy. For example, glycemic control, hyperlipidemia, and hypertension
should be managed with diet, exercise, and medications. Class I or II clinical
studies indicate that pregabalin, duloxetine, amitriptyline, gabapentin, and
opioids are effective in the management of diabetic neuropathic pain.