Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático
- dor (periférica)
- perda da sensação (periférica)
- disestesia (periférica)
- reflexos aquileus reduzidos ou ausentes (periféricos)
- lesões indolores (periféricas)
- taquicardia de repouso (autonômica)
- variabilidade da frequência cardíaca prejudicada (autonômica)
- polaciúria, urgência, noctúria, incontinência, hesitação, fluxo fraco ou retenção (autonômico)
- disfunção erétil (autonômica)
- diminuição do desejo sexual e aumento da dor durante a relação (autonômica)
- hipotensão ortostática (autonômica)
Other diagnostic factors
- constipação (autonômica)
- incontinência fecal (autonômica)
- anidrose, intolerância ao calor, pele seca ou hiperidrose (autonômica)
- hipoglicemia assintomática (autonômica)
- fraqueza (periférica)
- história de quedas recentes (periférica)
- ataxia de marcha (periférica)
- náuseas, vômitos pós-prandiais, distensão abdominal, perda de apetite, saciedade precoce (autonômico)
- pirose e disfagia para sólidos (autonômica)
- diarreia profusa e aquosa (autonômica)
- mononeuropatia específica (periférica)
- neuropatia craniana (periférica)
- dor sobre a parede abdominal ou torácica inferior (periférica)
- atrofia dos músculos da coxa, dor e fraqueza (periférica)
Risk factors
- hiperglicemia mal controlada
- duração prolongada do diabetes
- idade avançada (por exemplo, >70 anos)
- alta estatura
- hipertensão
- dislipidemia com triglicerídeos elevados
- coexistência de vários fatores de risco para doença cardiovascular (diabetes do tipo 2)
- doença renal
- obesidade
- desregulação imune
- tabagismo
- genética
Diagnostic investigations
1st investigations to order
- diagnóstico clínico
- glicemia de jejum
- HbA1c
- hormônio estimulante da tireoide sérico
- vitamina B12 sérica
- testes de função renal
- perfil lipídico sérico
- TFHs
- hemograma completo e velocidade de hemossedimentação
- imunoeletroforese de proteínas séricas/urinárias
Investigations to consider
- glicose plasmática de 2 horas
- estudos de condução nervosa (velocidade de condução nervosa, [VCN])
- eletromiografia (EMG)
- teste sensorial quantitativo (TSQ)
- biópsia de pele
- estudos dos reflexos cardiovasculares
- microscopia confocal da córnea
- variabilidade da frequência cardíaca (VFC)
- estudos de esvaziamento gástrico
- gastroduodenoscopia
- refeição de bário
- manometria gastrointestinal
- testes de hidrogênio no ar expirado
- ultrassonografia gástrica
- ressonância nuclear magnética (RNM) gástrica
- manometria anorretal
- gordura fecal
- teste de absorção da D-xilose
- urocultura
- cistometria, cistometrograma miccional
- ultrassonografia do trato urinário pós-miccional
- vídeo-urodinâmica
- testosterona (matinal)
Treatment algorithm
neuropatia periférica diabética
neuropatias cranianas
mononeuropatias dos membros ou tronculares
amiotrofia diabética
neuropatia autonômica diabética
Contributors
Authors
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
Disclosures
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
Disclosures
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
Disclosures
SA has received honoraria for educational meetings from AstraZeneca, Sanofi, Menarini, Eli Lilly, and Procter & Gamble.
Acknowledgements
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.
Disclosures
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.
Peer reviewers
Zachary T. Bloomgarden, MD
Clinical Professor
Department of Medicine
Mount Sinai School of Medicine
New York
NY
Disclosures
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
Disclosures
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
Disclosures
EJ has received funding for conferences and lectures from Pfizer and Boehringer Ingelheim.
References
Key articles
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
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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