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      Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments

      , MD, FRCP 1 , , MD 2 , , MD 3 , , MD 4 , , MD, PHD 5 , , MD, PHD 6 , , MD 7 , , MD 2 , , MD, PHD 8 , , MD, PHD 9 , , MD 10 , , MD 11 , on behalf of the Toronto Diabetic Neuropathy Expert Group

      Diabetes Care

      American Diabetes Association

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          Abstract

          Preceding the joint meeting of the 19th annual Diabetic Neuropathy Study Group of the European Association for the Study of Diabetes (NEURODIAB) and the 8th International Symposium on Diabetic Neuropathy in Toronto, Canada, 13–18 October 2009, expert panels were convened to provide updates on classification, definitions, diagnostic criteria, and treatments of diabetic peripheral neuropathies (DPNs), autonomic neuropathy, painful DPNs, and structural alterations in DPNs.

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          Most cited references 72

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          Diabetic neuropathies: a statement by the American Diabetes Association.

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            The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study.

            The magnitude of the health problem from diabetic neuropathies remains inadequately estimated due to the lack of prospective population-based studies employing standardized and validated assessments of the type and stage of neuropathy as compared with background frequency. All Rochester, Minnesota, residents with diabetes mellitus on January 1, 1986, were invited to participate in a cross-sectional and longitudinal study of diabetic neuropathies (and also of other microvascular and macrovascular complications). Of 64,573 inhabitants on January 1, 1986 in Rochester, 870 (1.3%) had clinically recognized diabetes mellitus (National Diabetes Data Group criteria), of whom 380 were enrolled in the Rochester Diabetic Neuropathy Study. Of these, 102 (26.8%) had insulin-dependent diabetes mellitus (IDDM), and 278 (73.2%) had non-insulin-dependent diabetes mellitus (NIDDM). Approximately 10% of diabetic patients had neurologic deficits attributable to nondiabetic causes. Sixty-six percent of IDDM patients had some form of neuropathy; the frequencies of individual types were as follows: polyneuropathy, 54%; carpal tunnel syndrome, asymptomatic, 22%, and symptomatic, 11%; visceral autonomic neuropathy, 7%, and other varieties, 3%. Among NIDDM patients, 59% had various neuropathies; the individual percentages were 45%, 29%, 6%, 5%, and 3%. Symptomatic degrees of polyneuropathy occurred in only 15% of IDDM and 13% of NIDDM patients. The more severe stage of polyneuropathy, to the point that patients were unable to walk on their heels and also had distal sensory and autonomic deficits (stage 2b) occurred even less frequently--6% of IDDM and 1% of NIDDM patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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              Diabetic Neuropathies: A statement by the American Diabetes Association

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                Author and article information

                Journal
                Diabetes Care
                diacare
                dcare
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                0149-5992
                1935-5548
                October 2010
                : 33
                : 10
                : 2285-2293
                Affiliations
                1Diabetes Research Unit, Sheffield Teaching Hospitals, Sheffield, U.K.;
                2Department of Medicine, University of Manchester, Manchester, U.K.;
                3Department of Neurology, Mayo Clinic, Rochester Minnesota;
                4Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts;
                5Department of Medicine, University of Adelaide, Adelaide, Australia;
                6I Department of Medicine, Semmelweis University, Budapest, Hungary;
                7Neuromuscular Diseases Unit, Istituto Di Ricovero e Cura a Carattere Scientifico Foundation, “Carlo Besta” Neurological Institute, Milan, Italy;
                8Department of Internal Medicine, University of Tor Vergata, Rome, Italy;
                9Strelitz Diabetes Research Institutes, Eastern Virginia Medical School, Norfolk, Virginia;
                10Clinica Medica 1, Universita' di Pavia, Pavia, Italy;
                11Service d'Endocrinologie-Diabétologie-Nutrition, Hôpital Jean Verdier, Assistance Publique-Hôpitaux de Paris, Université Paris Nord, Center for Research in Human Nutrition, Ile-de-France, Bondy, France.
                Author notes
                Corresponding author: Solomon Tesfaye, solomon.tesfaye@ 123456sth.nhs.uk .

                *A complete list of the members of the Toronto Diabetic Neuropathy Expert Group is provided in appendix .

                Article
                1303
                10.2337/dc10-1303
                2945176
                20876709
                © 2010 by the American Diabetes Association.

                Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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                Reviews/Commentaries/ADA Statements
                Review Article

                Endocrinology & Diabetes

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