Diabetic neuropathy
შეჯამება
განსაზღვრება
ანამნეზი და გასინჯვა
ძირითადი დიაგნოსტიკური ფაქტორები
- presence of risk factors
- asymptomatic
- pain (peripheral)
- loss of sensation (peripheral)
- dysaesthesia (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)
სხვა დიაგნოსტიკური ფაქტორები
- constipation (autonomic)
- faecal incontinence (autonomic)
- anhidrosis, heat intolerance, dry skin, or hyperhidrosis (autonomic)
- hypoglycaemia 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 diarrhoea (autonomic)
- specific mononeuropathy (peripheral)
- cranial neuropathy (peripheral)
- pain over lower thoracic or abdominal wall (peripheral)
- thigh muscle atrophy, pain, and weakness (peripheral)
რისკფაქტორები
- poorly controlled hyperglycaemia
- prolonged duration of diabetes
- older age (e.g., >70 years)
- tall stature
- hypertension
- dyslipidaemia with elevated triglycerides
- co-existence of multiple cardiovascular disease (CVD) risk factors (type 2 diabetes)
- renal disease
- obesity
- immune dysregulation
- smoking
- genetic
დიაგნოსტიკური კვლევები
1-ად შესაკვეთი გამოკვლევები
- clinical diagnosis
- fasting blood glucose
- HbA1c
- serum thyroid-stimulating hormone
- serum vitamin B12
- renal function tests
- serum lipid profile
- LFTs
- FBC and erythrocyte sedimentation rate
- serum/urine immunoelectrophoresis
გასათვალისწინებელი კვლევები
- 2-hour plasma glucose
- nerve conduction studies (nerve conduction velocity [NCV])
- electromyography (EMG)
- quantitative sensory testing (QST)
- skin biopsy
- cardiovascular 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
- faecal fat
- d-xylose test
- urine culture
- cystometry, voiding cystometrogram
- post-void urinary tract ultrasound
- video-urodynamics
- Testosterone (morning)
მკურნალობის ალგორითმი
diabetic peripheral neuropathy
cranial neuropathies
limb or truncal mononeuropathies
diabetic amyotrophy
diabetic autonomic neuropathy
კონტრიბუტორები
ავტორები
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
გაფრთხილება:
RAM has been reimbursed for being on the advisory board for an epidemiological 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, 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 a number of references cited in this topic.
Uazman Alam, BSc, MBChB, MPHe, PhD
Reader and Consultant Physician
University of Liverpool
Liverpool
UK
Declarações
UA has received honoraria from Procter & Gamble, Viatris, Grunenthal, Eli Lilly, and Sanofi for educational meetings. UA has also received investigator-led funding from Procter & Gamble.
Shazli Azmi, MBchB, MRCP
Consultant Physician
Diabetes and Endocrinology
Central Manchester Foundation Trust
University of Manchester
Manchester
UK
Declarações
SA has received honoraria for educational meetings from AstraZeneca, Sanofi, Menarini, Eli Lilly, and Procter & Gamble.
Agradecimentos
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.
Declarações
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.
Revisores
Zachary T. Bloomgarden, MD
Clinical Professor
Department of Medicine
Mount Sinai School of Medicine
New York
NY
Declarações
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
Declarações
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
Declarações
EJ has received funding for conferences and lectures from Pfizer and Boehringer Ingelheim.
Créditos aos pareceristas
Os tópicos do BMJ Best Practice são constantemente atualizados, seguindo os desenvolvimentos das evidências e das diretrizes. Os pareceristas aqui listados revisaram o conteúdo pelo menos uma vez durante a história do tópico.
Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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.Texto completo Resumo
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.Texto completo Resumo
American Diabetes Association Professional Practice Committee. Introduction and methodology: standards of care in diabetes-2025. Diabetes Care. 2025 Jan 1;48(1 suppl 1):S1-5.Texto completo Resumo
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.Texto completo Resumo
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.Texto completo Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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