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Diabetic neuropathy

  • Обзор
  • Теория
  • Диагноз
  • Лечение
  • Последующее наблюдение
  • Источники
Последний просмотренный: 25 Aug 2026
Last updated: 29 Jan 2026

Резюме

Определение

Анамнез и осмотр

Ключевые диагностические факторы

  • asymptomatic
  • pain (peripheral)
  • loss of sensation (peripheral)
  • dysesthesia (peripheral)
  • reduced or absent ankle reflexes (peripheral)
  • painless injuries (peripheral)
  • resting tachycardia (autonomic)
  • impaired heart rate variability (autonomic)
  • urinary frequency, urgency, nocturia, incontinence, hesitancy, weak stream, or retention (autonomic)
  • erectile dysfunction (autonomic)
  • decreased sexual desire and increased pain during intercourse (autonomic)
  • orthostatic hypotension (autonomic)
Полная информация

Другие диагностические факторы

  • constipation (autonomic)
  • fecal incontinence (autonomic)
  • anhidrosis, heat intolerance, dry skin, or hyperhidrosis (autonomic)
  • hypoglycemia unawareness (autonomic)
  • weakness (peripheral)
  • history of recent falls (peripheral)
  • gait ataxia (peripheral)
  • nausea, postprandial vomiting, bloating, loss of appetite, early satiety (autonomic)
  • heartburn and dysphagia for solids (autonomic)
  • profuse and watery diarrhea (autonomic)
  • specific mononeuropathy (peripheral)
  • cranial neuropathy (peripheral)
  • pain over lower thoracic or abdominal wall (peripheral)
  • thigh muscle atrophy, pain, and weakness (peripheral)
Полная информация

Факторы риска

  • poorly controlled hyperglycemia
  • prolonged duration of diabetes
  • older age (e.g., >70 years)
  • tall stature
  • hypertension
  • dyslipidemia with elevated triglycerides
  • coexistence of multiple cardiovascular disease (CVD) risk factors (type 2 diabetes)
  • renal disease
  • obesity
  • immune dysregulation
  • smoking
  • genetic
Полная информация

Диагностические исследования

Исследования, которые показаны в первую очередь

  • clinical diagnosis
  • fasting blood glucose
  • HbA1c
  • serum thyroid-stimulating hormone
  • serum vitamin B12
  • renal function tests
  • serum lipid profile
  • LFTs
  • CBC and erythrocyte sedimentation rate
  • serum/urine immunoelectrophoresis
Полная информация

Tests to avoid

  • MRI spine or brain
Полная информация

Исследования, проведение которых нужно рассмотреть

  • 2-hour plasma glucose
  • nerve conduction studies (nerve conduction velocity [NCV])
  • electromyography (EMG)
  • quantitative sensory testing (QST)
  • skin biopsy
  • cardiovascular autonomic reflex testing
  • corneal confocal microscopy
  • heart rate variability (HRV)
  • gastric emptying studies
  • gastroduodenoscopy
  • barium meal
  • gastrointestinal manometry
  • hydrogen breath tests
  • gastric ultrasonography
  • gastric MRI
  • anorectal manometry
  • fecal fat
  • serologic tests for celiac disease
  • D-xylose test
  • urine culture
  • cystometry, voiding cystometrogram
  • postvoid urinary tract ultrasound
  • video-urodynamics
  • testosterone (morning)
Полная информация

Алгоритм лечения

ПРОДОЛЖЕНИЕ

diabetic peripheral neuropathy

cranial neuropathies

limb or truncal mononeuropathies

diabetic amyotrophy

diabetic autonomic neuropathy

Составители

Авторы

Rayaz A. Malik, BSc (Hons), MSc, MBChB, FRCP, PhD

Professor of Medicine

Organizational Official for the Human Research Protection Program

Weill Cornell Medicine - Qatar

Doha

Qatar

Раскрытие информации

RAM has been reimbursed for being on the advisory board for an epidemiologic study on cardiovascular disease in type 2 diabetes and to give educational lectures on treatment of diabetes undertaken by Novo Nordisk. RAM has been reimbursed for educational lectures for Sanofi Aventis, Viatris, Lilly, and Proctor and Gamble (P&G). RAM has received an investigator-initiated grant to study long COVID from P&G. RAM is an author of references cited in this topic.

Uazman Alam, BSc, MBChB, MPHe, PhD

Reader and Consultant Physician

University of Liverpool

Liverpool

UK

Раскрытие информации

UA has received honoraria from Procter & Gamble, Viatris, Grunenthal, Eli Lilly, Theras, and Sanofi for educational meetings. UA has also received investigator-led study funding from Procter & Gamble. UA declares attendance to educational meetings sponsored by Eli Lilly, Sanofi, and Daiichi Sankyo.

Shazli Azmi, MBchB, MRCP

Consultant Physician

Diabetes and Endocrinology

Central Manchester Foundation Trust

University of Manchester

Manchester

UK

Раскрытие информации

SA has received honoraria for educational meetings from AstraZeneca, Sanofi, Menarini, Eli Lilly, and Procter & Gamble.

Выражение благодарностей

Dr Rayaz Malik, Dr Uazman Alam, and Dr Shazli Azmi would like to gratefully acknowledge Dr Rodica Pop-Busui and Dr Eva Feldman, the previous contributors to this topic.

Раскрытие информации

RPB declares that she has received speaking honoraria from Pfizer and research support from Amylin Pharmaceuticals; National Institutes of Health/National Heart, Lung, and Blood Institute; National Institute of Health/National Institute of Diabetes and Digestive and Kidney Diseases; American Diabetes Association; and Juvenile Diabetes Research Foundation. RPB and EF are authors of references cited in this topic.

Рецензенты

Zachary T. Bloomgarden, MD

Clinical Professor

Department of Medicine

Mount Sinai School of Medicine

New York

NY

Раскрытие информации

ZTB declares that he has no competing interests.

Rajesh K. Garg, MD

Assistant Professor of Medicine

Harvard Medical School

Division of Endocrinology

Diabetes and Hypertension

Brigham and Women's Hospital

Boston

MA

Раскрытие информации

RKG has received consultant fees from Aventis and Novartis, and speaker fees from Novartis.

Edward Jude, MBBS, MD, MRCP, DNB

Consultant and Honorary Senior Lecturer

Tameside General Hospital

Diabetes Centre

Ashton Under Lyne

Lancashire

UK

Раскрытие информации

EJ has received funding for conferences and lectures from Pfizer and Boehringer Ingelheim.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

Список литературы

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Основные статьи

Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017 Jan;40(1):136-54.Полный текст  Аннотация

Dyck PJ, Albers JW, Andersen H, et al; Toronto Expert Panel on Diabetic Neuropathy. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev. 2011 Oct;27(7):620-8.Полный текст  Аннотация

American Diabetes Association Professional Practice Committee. Standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-352.Полный текст  Аннотация

Price R, Smith D, Franklin G, et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary. Report of the AAN Guideline Subcommittee. Neurology. 2022 Jan 4;98(1):31-43.Полный текст  Аннотация

Senneville E, Albalawi Z, van Asten SA, et al. IWGDF/IDSA guidelines on the diagnosis and treatment of diabetes-related foot infections. Clin Infect Dis. 2023 Oct 2:ciad527.Полный текст  Аннотация

Статьи, указанные как источники

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

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