Risk Factors and Comorbidities in Diabetic Neuropathy: An Update 2015

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The Review of Diabetic Studies,2015,12,1-2,48-62.
Published:August 2015
Type:Review Article
Author(s) affiliations:

Nikolaos Papanas1 and Dan Ziegler2,3

1Diabetes Clinic, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, GREECE.

2Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Leibniz Center for Diabetes Research.

3Department of Endocrinology and Diabetology, Medical Faculty, Heinrich Heine University, Düsseldorf, GERMANY. 


Distal symmetric sensorimotor polyneuropathy (DSPN) is the most common neurological manifestation in diabetes. Major risk factors of DSPN include diabetes duration, hyperglycemia, and age, followed by prediabetes, hypertension, dyslipidemia, and obesity. Height, smoking, insulin resistance, hypoinsulinemia, and others represent an additional risk. Importantly, hyperglycemia, hypertension, dyslipidemia, obesity, and smoking are modifiable. Stringent glycemic control has been shown to be effective in type 1, but not to the same extent in type 2 diabetes. Antilipidemic treatment, especially with fenofibrate, and multi-factorial intervention have produced encouraging results, but more experience is necessary. The major comorbidities of DSPN are depression, autonomic neuropathy, peripheral artery disease, cardiovascular disease, nephropathy, retinopathy, and medial arterial calcification. Knowledge of risk factors and comorbidities has the potential to enrich the therapeutic strategy in clinical practice as part of the overall medical care for patients with neuropathy. This article provides an updated overview of DSPN risk factors and comorbidities.