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• W2550556500 abstract "Aki Hietaharju, MD, PhD Tampere University Hospital Department of Neurology and Rehabilitation PO Box 2000, 33521 Tampere, Finland Email: aki.hietaharju@pshp.fi D iabetes is a worldwide epidemic with a global prevalence of 8.3 %, and its prevalence is likely to increase in tandem with the global epidemic of obesity. Diabetic neuropathy is th most common complication of diabetes, and risk of developing it increases with the duration of diabetes. On the other hand, even patients with impaired glucose tolerance develop painful neuropathic symptoms and damage to small nerve fibers. Symptoms of diabetic polyneuropathy manifest earlier in type 2 diabetes than in type 1 diabetes. In type 2 diabetes, 8% of patients have neuropathy at the time of diagnosis, and up to 50% of older type 2 diabetic patients have evidence of a distal neuropathy. Poor glycemic control is the most important risk factor for diabetic neuropathy, and according to high-quality evidence, enhanced glucose control significantly prevents the development of clinical neuropathy in type 1 diabetes mellitus. A meta-analysis showed that enhanced glucose control reduces the incidence of clinical neuropathy, although this finding was not statistically significant. In addition to glucose control, other potentially modifiable cardiovascular risk factors such as higher levels of total and low-density lipoprotein cholesterol and triglycerides, higher body-mass index, smoking, and hypertension also increase the risk of neuropathy. The clinical features of the diabetic neuropathies vary immensely, and only a minority of patients with neuropathy will experience pain. According to a large community-based study from England, one third of patients with diabetes have painful neuropathy symptoms. Painful diabetic neuropathy was more prevalent in patients with type 2 diabetes and in women. In a recent systematic review of epidemiological studies of neuropathic pain in the general population, the population prevalence of painful diabetic neuropathy was calculated at 0.8%. Incidence rates of painful diabetic polyneuropathy ranged from 15.3/100,000 person-years to 72.3/100,000. The natural history of painful diabetic neuropathy remains unclear, although in a small longitudinal study, one-fourth of the patients experienced remission of pain whereas the rest still had pain after 5 years. In a small study, dietary management and an exercise program resulted in improvement of painful symptoms and intraepidermal nerve fiber density in patients with impaired glucose tolerance and small-fiber neuropathy." @default.
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• W2550556500 date "2015-01-01" @default.
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• W2550556500 title "Halting the March of Painful Diabetic Neuropathy" @default.
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