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Review
. 2012 Oct;25(5):536-41.
doi: 10.1097/WCO.0b013e328357a797.

Diabetic neuropathy: one disease or two?

Brian C Callaghan  1 , Junguk Hur, Eva L Feldman
Affiliations
Review

Diabetic neuropathy: one disease or two?

Brian C Callaghan et al. Curr Opin Neurol. 2012 Oct.

Abstract

Purpose of review: To compare and contrast the evidence for the effect of glucose control on the prevention of neuropathy in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).

Recent findings: In T1DM, multiple clinical trials have demonstrated a large benefit from enhanced glucose control, whereas the benefit in T2DM is much more modest. Epidemiologic and laboratory evidence exists to support factors other than hyperglycemia in the development of neuropathy including obesity, hypertension, dyslipidemia, inflammation, and insulin resistance.

Summary: T1DM neuropathy and T2DM neuropathy are fundamentally different. In T1DM, glucose control has a large effect on the prevention of neuropathy; therefore, future efforts should continue to concentrate on this avenue of treatment. In contrast, in T2DM, glucose control has a small effect on the prevention of neuropathy; as a result, more research is needed to define the underlying mechanisms for the development of neuropathy. Understanding these mechanisms may lead to novel therapeutic approaches to prevent or treat diabetic neuropathy.

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References

    1. Centers for Disease Control and Prevention . National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; Atlanta, GA: 2011. *A presentation of the most recent diabetes statistics for the United States population.
    1. Vincent AM, Callaghan BC, Smith AL, Feldman EL. Diabetic neuropathy: cellular mechanisms as therapeutic targets. Nat Rev Neurol. 2011 Oct;7(10):573–83. ** A comprehensive review discussing newly emerging ideas on the pathogenesis of diabetic neuropathy, including the concept that dyslipidemia is likely as important as hyperglycemia in the onset and progression of diabetic neuropathy. - PubMed
    1. Callaghan B, Little A, Feldman EL, Hughes RAC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012 In Press. ** A recent Cochrane review reporting all studies investigating the impact of glycemic control on diabetic neuropathy. The review concludes that glycemic control is more important for patients with type 1 than those with type 2 diabetes with respect to either preventing or treating diabetic neuropathy. - PMC - PubMed
    1. Callaghan B, Cheng HT, Stables CL, Smith AL, Feldman EL. Diabetic neuropathy: clinical manifestations and current treatments. Lancet Neurol. 2012;11:521–34. **A comprehensive review of both the pathogenesis and treatment of diabetic neuropathy. The recent American Academy of Neurology guidelines for the treatment of painful diabetic neuropathy are compared to the European guidelines. - PMC - PubMed
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