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Diabetic Neuropathy

Diabetic neuropathy (DN) may be a heterogeneous set of clinical or subclinical manifestations affecting the peripheral systema nervous (PNS) as complication of DM (DM). it's going to have different clinical manifestations, pathophysiologic mechanisms, onset and evolution1,2. it had been only in 1864 that DM was recognized as explanation for peripheral neuropathy (PN). Some years later, the involvement of cranial nerves of diabetic patients has been observed3 . The loss of tendinous reflexes in lower limbs (LLll) was described by Bouchard in 18844 and therefore the presence of spontaneous symptoms like pain and hyperesthesia was described by Pavy in 18855 . Motor manifestations were documented by Buzzard in 18906 .

The first DN classification was suggested by Leyden (1893)7 who subdivided it in sensory and motor manifestations. Jordon and Crabtree (1935)8 successively , were the primary to say pathophysiologic DN mechanisms. After the invention of insulin within the 1930s to treat DM, the prevalence of DN has significantly increased since diabetic patients began to have longer life expectation. Studies by Fagerberg9 , Mulder et al.10 and Pirart, Lauvaux and Rey11, have proven the correlation of DN with other micro vascular complications like diabetic nephropathy and retinopathy12.

In face of an alarming number of DM patients, the prevalence of DN is following this growth and is already appearing as major explanation for NP in developed countries. One should stress that for being the foremost prevalent micro vascular complication, it's estimated that a minimum of half the diabetic patients shall develop this neuropathy in some moment of their clinical evolution13. Distal symmetrical polyneuropathy is its most frequent clinical presentation, being generally asymptomatic14. but half the patients have some sort of neuropathic symptom, being mostly sensory symptoms15. Among DN patients, approximately 20% have neuropathic pain, implying significant decrease in quality of life and functional capacity16.

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