Neuropatías diabéticas

The mechanism by which lack of glycemic control predisposes to diabetic neuropathy is incompletely understood. A complex array of metabolic and vascular factors and repair factors of the nerve fiber has been implicated. The diabetic neuropathies are heterogeneous and affecting different parts of the nervous system. Distal symmetric polyneuropathy and autonomic neuropathy are the most common among the neuropathies. Other forms less prevalent are radiculopathies, mononeuropathies, and mononeuropathy multiplex. The diagnosis of the diabetic polyneuropathy is based on the subjective interpretation of a constellation of symptoms and signs in a diabetic patient and involves the exclusion of nondiabetic causes if there is any aspect of the history or clinical presentation suggesting atypical features. The most important treatment in the prevention of diabetic neuropathy and in the management of pain in patients with distal symmetric polyneuropathy should be to aim for stable and optimal glycemic control. Treatments that may be beneficial for painful diabetic neuropathy include a number of antidepressants and anticolvulsants as well as capsaicin cream. The management of autonomic neuropathy is based in symptomatic treatments.