From the Guidelines
Diabetic neuropathy typically presents with numbness, tingling, or burning sensations in the extremities, and can also manifest as autonomic neuropathy with symptoms such as orthostatic hypotension, gastroparesis, and abnormal sweating patterns, as noted in the most recent guidelines 1. The clinical signs of diabetic neuropathy can vary depending on the type and severity of nerve damage.
- The most common signs include:
- Numbness, tingling, or burning sensations in the extremities, typically beginning in the toes and feet before progressing upward in a "stocking-glove" distribution
- Sharp, shooting, or electric-like pain that may worsen at night
- Decreased sensation to light touch, temperature, vibration, and proprioception on physical examination
- Diminished or absent ankle reflexes as an early sign
- Muscle weakness and atrophy can develop in advanced cases
- Autonomic neuropathy can manifest as:
- Orthostatic hypotension
- Gastroparesis (causing nausea, vomiting, early satiety)
- Erectile dysfunction
- Neurogenic bladder
- Abnormal sweating patterns
- Skin changes such as dryness, calluses, and painless ulcers may develop due to decreased sensation and altered blood flow, and Charcot joint deformities can occur in severe cases, as discussed in previous guidelines 1. The diagnosis of diabetic neuropathy is a clinical one, relying on the patient’s description of pain and symptoms, and can be supported by nerve conduction studies and quantitative sensory testing, as recommended in earlier studies 1. Regular foot examinations, glycemic control, and early intervention are essential to prevent progression and complications of diabetic neuropathy, as emphasized in the most recent guidelines 1.
From the Research
Clinical Signs of Diabetic Neuropathy
The clinical signs of diabetic neuropathy can vary, but common symptoms include:
- Numbness, tingling, pain, and loss of sensation in the extremities 2
- Burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands 3
- Tingling, burning, lancinating pain, hyperesthesia, and allodynia 4
- Painful neuropathic symptoms, such as pain, which can be a warning signal of tissue damage 5, 6
Diagnosis and Classification
Diabetic neuropathy can be either painful or non-painful, and diagnosis can be challenging due to the lack of a biomarker or clear consensus on the clinical definition 6. A hierarchical classification has been developed to categorize the probability of the diagnosis into possible, probable, or definite, based on the clinical presentation of symptoms and signs 6.
Progression and Quality of Life
The natural history of the disease may vary from intermittent mild symptoms to severe chronic daily pain, which can be associated with diminished quality of life 4. Diabetic neuropathy can significantly affect quality of life, and early detection and interventions are crucial to prevent further neuronal damage and lower the economic burden of this complication 6.