Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes

Overview

Journal Curr Diab Rep

Publisher Current Science

Specialty Endocrinology

Date 2019 Aug 29

PMID 31456118

Citations 234

Authors

Caitlin W Hicks

Elizabeth Selvin

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: Diabetic peripheral neuropathy eventually affects nearly 50% of adults with diabetes during their lifetime and is associated with substantial morbidity including pain, foot ulcers, and lower limb amputation. This review summarizes the epidemiology, risk factors, and management of diabetic peripheral neuropathy and related lower extremity complications.

Recent Findings: The prevalence of peripheral neuropathy is estimated to be between 6 and 51% among adults with diabetes depending on age, duration of diabetes, glucose control, and type 1 versus type 2 diabetes. The clinical manifestations are variable, ranging from asymptomatic to painful neuropathic symptoms. Because of the risk of foot ulcer (25%) and amputation associated with diabetic peripheral neuropathy, aggressive screening and treatment in the form of glycemic control, regular foot exams, and pain management are important. There is an emerging focus on lifestyle interventions including weight loss and physical activity as well. The American Diabetes Association has issued multiple recommendation statements pertaining to diabetic neuropathies and the care of the diabetic foot. Given that approximately 50% of adults with diabetes will be affected by peripheral neuropathy in their lifetime, more diligent screening and management are important to reduce the complications and health care burden associated with the disease.

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References

Pop-Busui R, Lu J, Lopes N, Jones T . Prevalence of diabetic peripheral neuropathy and relation to glycemic control therapies at baseline in the BARI 2D cohort. J Peripher Nerv Syst. 2009; 14(1):1-13. PMC: 2692660. DOI: 10.1111/j.1529-8027.2009.00200.x. View

Lim J, Ng N, Thomas C . Prevention and treatment of diabetic foot ulcers. J R Soc Med. 2017; 110(3):104-109. PMC: 5349377. DOI: 10.1177/0141076816688346. View

Massie R, Mauermann M, Staff N, Amrami K, Mandrekar J, Dyck P . Diabetic cervical radiculoplexus neuropathy: a distinct syndrome expanding the spectrum of diabetic radiculoplexus neuropathies. Brain. 2012; 135(Pt 10):3074-88. DOI: 10.1093/brain/aws244. View

Harati Y, Gooch C, Swenson M, Edelman S, Greene D, Raskin P . Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998; 50(6):1842-6. DOI: 10.1212/wnl.50.6.1842. View

Brem H, Sheehan P, Rosenberg H, Schneider J, Boulton A . Evidence-based protocol for diabetic foot ulcers. Plast Reconstr Surg. 2006; 117(7 Suppl):193S-209S. DOI: 10.1097/01.prs.0000225459.93750.29. View

Nathan D, Genuth S, Lachin J, Cleary P, Crofford O, Davis M . The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med. 1993; 329(14):977-86. DOI: 10.1056/NEJM199309303291401. View

Martin C, Albers J, Pop-Busui R . Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care. 2013; 37(1):31-8. PMC: 3868000. DOI: 10.2337/dc13-2114. View

Janghorbani M, van Dam R, Willett W, Hu F . Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007; 166(5):495-505. DOI: 10.1093/aje/kwm106. View

Dyck P, Kratz K, Karnes J, Litchy W, Klein R, Pach J . The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993; 43(4):817-24. DOI: 10.1212/wnl.43.4.817. View

10.

Gregg E, Gu Q, Williams D, de Rekeneire N, Cheng Y, Geiss L . Prevalence of lower extremity diseases associated with normal glucose levels, impaired fasting glucose, and diabetes among U.S. adults aged 40 or older. Diabetes Res Clin Pract. 2007; 77(3):485-8. DOI: 10.1016/j.diabres.2007.01.005. View

11.

Tesfaye S, Stevens L, Stephenson J, Fuller J, Plater M, Ionescu-Tirgoviste C . Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia. 1996; 39(11):1377-84. DOI: 10.1007/s001250050586. View

12.

Malik R, Veves A, Walker D, Siddique I, Lye R, Schady W . Sural nerve fibre pathology in diabetic patients with mild neuropathy: relationship to pain, quantitative sensory testing and peripheral nerve electrophysiology. Acta Neuropathol. 2001; 101(4):367-74. DOI: 10.1007/s004010000287. View

13.

Hanewinckel R, Ikram M, van Doorn P . Peripheral neuropathies. Handb Clin Neurol. 2016; 138:263-82. DOI: 10.1016/B978-0-12-802973-2.00015-X. View

14.

Albers J, Brown M, Sima A, Greene D . Frequency of median mononeuropathy in patients with mild diabetic neuropathy in the early diabetes intervention trial (EDIT). Tolrestat Study Group For Edit (Early Diabetes Intervention Trial). Muscle Nerve. 1996; 19(2):140-6. DOI: 10.1002/(SICI)1097-4598(199602)19:2<140::AID-MUS3>3.0.CO;2-E. View

15.

Smith B . Focal and entrapment neuropathies. Handb Clin Neurol. 2014; 126:31-43. DOI: 10.1016/B978-0-444-53480-4.00003-5. View

16.

Gimbel J, Richards P, Portenoy R . Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology. 2003; 60(6):927-34. DOI: 10.1212/01.wnl.0000057720.36503.2c. View

17.

Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson D . Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018; 40(6):828-849. DOI: 10.1016/j.clinthera.2018.04.001. View

18.

Zhao Y, Wu N, Chen S, Boulanger L, Police R, Fraser K . Changes in opioid use and healthcare costs among U.S. patients with diabetic peripheral neuropathic pain treated with duloxetine compared with other therapies. Curr Med Res Opin. 2010; 26(9):2147-56. DOI: 10.1185/03007995.2010.503140. View

19.

Jaiswal M, Lauer A, Martin C, Bell R, Divers J, Dabelea D . Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care. 2013; 36(12):3903-8. PMC: 3836139. DOI: 10.2337/dc13-1213. View

20.

Boulton A . Diabetic neuropathy and foot complications. Handb Clin Neurol. 2014; 126:97-107. DOI: 10.1016/B978-0-444-53480-4.00008-4. View