Recent advances in the diagnosis and treatment of diabetic neuropathy

Diabetic neuropathy encompasses a wide range of subclinical and clinical syndromes. Here we dis cuss the pathologic and pathogenetic heterogeneity displayed among patients with chronic diabetic neurologic complications. In addition to the traditional approach that associates neuropathy with persistently high blood glucose and/or microvascular insufficiency, the most recent observations related to the role of immune mechanisms and deficiency of neurotrophic factors also are presented. Diagnostic procedures should include a thorough evaluation of clinical, electrophysiologic, and quantitative sensory and autonomic function testing. An important diagnostic element is screening for signs of antineuronal autoimmunity. This may dictate the therapeutic intervention, Immunotherapy in those patients who present with circulating antineuronal antibodies or immunopathologic findings in the nerve that are consistent with immune attack may be appropriate, In addition, we describe algorithms for recognition and management of painful diabetic neuropathy and specialized treatments based on our better understanding of their etiopathogenesis.