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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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          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 65

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          Neuropathic pain: redefinition and a grading system for clinical and research purposes.

          Pain usually results from activation of nociceptive afferents by actually or potentially tissue-damaging stimuli. Pain may also arise by activity generated within the nervous system without adequate stimulation of its peripheral sensory endings. For this type of pain, the International Association for the Study of Pain introduced the term neuropathic pain, defined as "pain initiated or caused by a primary lesion or dysfunction in the nervous system." While this definition has been useful in distinguishing some characteristics of neuropathic and nociceptive types of pain, it lacks defined boundaries. Since the sensitivity of the nociceptive system is modulated by its adequate activation (e.g., by central sensitization), it has been difficult to distinguish neuropathic dysfunction from physiologic neuroplasticity. We present a more precise definition developed by a group of experts from the neurologic and pain community: pain arising as a direct consequence of a lesion or disease affecting the somatosensory system. This revised definition fits into the nosology of neurologic disorders. The reference to the somatosensory system was derived from a wide range of neuropathic pain conditions ranging from painful neuropathy to central poststroke pain. Because of the lack of a specific diagnostic tool for neuropathic pain, a grading system of definite, probable, and possible neuropathic pain is proposed. The grade possible can only be regarded as a working hypothesis, which does not exclude but does not diagnose neuropathic pain. The grades probable and definite require confirmatory evidence from a neurologic examination. This grading system is proposed for clinical and research purposes.
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            Diabetic cardiovascular autonomic neuropathy.

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              Diabetic neuropathies: a statement by the American Diabetes Association.


                Author and article information

                Diabetes Care
                Diabetes Care
                Diabetes Care
                American Diabetes Association
                October 2010
                : 33
                : 10
                : 2285-2293
                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@ .

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

                © 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 for details.

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                Endocrinology & Diabetes


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