Diabetic neuropathy

IntroductionDiabetes mellitus is gradually rising in global ranks of mortality and according to the World Health Organization it is estimated to occupy the seventh place by the year 2030. Diabetic neuropathy (DN) is the most common complication of diabetes and the symmetric distal polyneuropathy is its predominant form. Currently there are several clinical classifications of DN. Etiopathogenesis is presently the object of intense research and is yet to be fully comprehended.AimThe purpose of this paper is to present and systematize the current state of knowledge on DN, in particular distal symmetric polyneuropathy. We hope that this would be helpful in the prevention, diagnosis and treatment of DN.Material and methodsIt was based upon the available literature, publications and materials available in the online medical databases.DiscussionProlonged exposure to hyperglycemia is recognized as the major mechanism and the risk factors include, among others, the degree of metabolic control of diabetes mellitus. Neuropathic symptoms result from the severity of nerve fiber damage. Nevertheless, in more than 50% of cases pain is the predominant symptom, which should encourage popularization of the use of quality of life questionnaires in diabetics. The primary and most important elements of causal treatment include the proper level of metabolic equalization, blood pressure normalization and cessation of stimulant use. Apparently the only drug influencing pathogenetic mechanisms is alpha-lipoic acid, efficiency of which has been confirmed in the ALLADYN and the SYDNEY trials.ConclusionsIn light of the current state of knowledge, recommended first line medication in the treatment of pain associated with DN includes: tricyclic antidepressant, serotonin-norepinephrine reuptake inhibitor or antiepileptic drug. If monotherapy proves ineffective, adding a second drug may be considered, then adjuvant opioid and alternatively non-pharmacological treatment. In case of lack of response to treatment, stimulation of the spinal cord can be the final intervention.