Διαβητική Νευροπάθεια: Πηγές και Επιλεγμένες Ανασκοπήσεις
* Ελληνική Διαβητολογική Εταιρεία (Ε.Δ.Ε.) – Κατευθυντήριες οδηγίες για τον Σακχαρώδη Διαβήτη (2024) 
Ως Διαβητική Νευροπάθεια (ΔΝ) χαρακτηρίζεται η παρουσία συμπτωμάτων ή/και σημείων δυσλειτουργίας των νεύρων σε άτομα με ΣΔ μετά από αποκλεισμό άλλων αιτίων νευροπάθειας. Η συχνότητα νευροπάθειας από άλλα αίτια, τα οποία συνήθως είναι αλκοολισμός, έλλειψη βιταμίνης Β12 και βλάβες νεύρων από πίεση (σύνδρομο παγίδευσης νεύρων, όπως π.χ. το σύνδρομο καρπιαίου σωλήνα, τα οποία εμφανίζονται με αυξημένη συχνότητα στον ΣΔ), ανέρχεται σε ποσοστό περίπου 10%. Επομένως ο έλεγχος για τον αποκλεισμό τους δεν πρέπει να παραλείπεται. Δεν υπάρχουν παθογνωμονικά ευρήματα για τη ΔΝ και ως εκ τούτου τα χρησιμοποιούμενα διαγνωστικά κριτήρια συχνά μεταβάλλονται και ποικίλλουν, με αποτέλεσμα να μην υπάρχουν ακριβή στοιχεία για τη συχνότητα της ΔΝ. Ως εκ τούτου, η αναφερόμενη στις διάφορες μελέτες συχνότητα ΔΝ
κυμαίνεται από 20-50% ή και περισσότερο.
Ταξινόμηση – Παθογένεια:
Δεν υπάρχει ομοφωνία στη διεθνή βιβλιογραφία για την ταξινόμηση και την παθογένεια της ΔΝ. Κατά την πιο πρακτική από κλινικής πλευράς ταξινόμηση, η ΔΝ διακρίνεται σε:
1. Συμμετρική Αισθητικοκινητική ή Περιφερική Νευροπάθεια (ΣΠΝ).
2. Νευροπάθεια του Αυτόνομου Νευρικού Συστήματος (ΝΑΝΣ).
3. Ειδικά Σύνδρομα:
3α. Μονονευροπάθεια εστιακή ή πολυεστιακή.
3β. Επώδυνη νευροπάθεια.
3γ. Διαβητική μυατροφία.
3δ. Θωρακοκοιλιακή νευροπάθεια.
3ε. Οξεία νευροπάθεια λόγω ταχείας ρύθμισης της γλυκαιμίας.
Μερικές μορφές της ΔΝ εμφανίζονται οξέως και είναι αναστρέψιμες, ενώ οι συχνότερες μορφές είναι χρόνιες και εξελικτικές, με λανθάνουσα έναρξη όπου δεν παρατηρείται επάνοδος της λειτουργίας των νευρικών στελεχών στα φυσιολογικά επίπεδα, δηλαδή οι βλάβες είναι μη αναστρέψιμες. Η παθογένεια της ΔΝ δεν είναι απόλυτα διευκρινισμένη, αλλά σ’ αυτήν συμμετέχουν διαταραχές του μεταβολισμού και της αιματώσεως των νεύρων. Περισσότερα (πλήρες άρθρο, σελίδες 227 – 236)
* American Diabetes Association (A.D.A.) – Standards of Care in Diabetes (2025)
Neuropathy – Screening – Recommendations
12.17 All people with diabetes should be assessed for diabetic peripheral neuropathy starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes and at least annually thereafter. B
12.18 Assessment for distal symmetric polyneuropathy should include a careful history and assessment of either temperature or pinprick sensation (small-fiber function) and vibration sensation using a 128-Hz tuning fork (for large-fiber function). All people with diabetes should have annual 10-g monofilament testing to identify feet at risk for ulceration and amputation. B
12.19 Symptoms and signs of autonomic neuropathy should be assessed in people with diabetes starting at diagnosis of type 2 diabetes and 5 years after the diagnosis of type 1 diabetes, and at least annually thereafter, and with evidence of other microvascular complications, particularly kidney disease and diabetic peripheral neuropathy. Screening can include asking about orthostatic dizziness, syncope, early satiety, erectile dysfunction, changes in sweating patterns, or dry cracked skin in the extremities. Signs of autonomic neuropathy include orthostatic hypotension, a resting tachycardia, or evidence of peripheral dryness or cracking of skin. E
Diabetic neuropathies are a heterogeneous group of disorders with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in people with diabetes is important. Points to be aware of include the following:
1. Diabetic neuropathy is a diagnosis of exclusion. Non–diabetic neuropathies may be present in people with diabetes and may be treatable.
2. Up to 50% of diabetic peripheral neuropathy may be asymptomatic. If not recognized and if preventive foot care is not implemented, people with diabetes are at risk for injuries as well as diabetic foot ulcers (DFUs) and amputations.
3. Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life.
Specific treatment to reverse the underlying nerve damage is currently not available. Glycemic management can effectively prevent diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) in type 1 diabetes (50,51) and may modestly slow their progression in type 2 diabetes (52), but it does not reverse neuronal loss. Treatments of other modifiable risk factors (including obesity, lipids, and blood pressure) can aid in prevention of DPN progression in type 2 diabetes and may reduce disease progression in type 1 diabetes (53–56). Therapeutic strategies (pharmacologic and nonpharmacologic) for the relief of painful DPN and symptoms of autonomic neuropathy can potentially reduce pain (57) and improve quality of life. Read more (full article)
* Diabetic Neuropathy: A Position Statement by the American Diabetes Association (2017)
Introduction: Diabetic neuropathies are the most prevalent chronic complications of diabetes. This heterogeneous group of conditions affects different parts of the nervous system and presents with diverse clinical manifestations. The early recognition and appropriate management of neuropathy in the patient with diabetes is important for a number of reasons: Diabetic neuropathy is a diagnosis of exclusion. Nondiabetic neuropathies may be present in patients with diabetes and may be treatable by specific measures. A number of treatment options exist for symptomatic diabetic neuropathy. Up to 50% of diabetic peripheral neuropathies may be asymptomatic. If not recognized and if preventive foot care is not implemented, patients are at risk for injuries to their insensate feet. Recognition and treatment of autonomic neuropathy may improve symptoms, reduce sequelae, and improve quality of life. Among the various forms of diabetic neuropathy, distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are by far the most studied (1–4). There are several atypical forms of diabetic neuropathy as well (1–4). Patients with prediabetes may also develop neuropathies that are similar to diabetic neuropathies (5–10). Table 1 provides a comprehensive classification scheme for the diabetic neuropathies. Read more (full article)
* NIH – National Library of Medicine (NCBI) USA – StatPearls Diabetic Peripheral Neuropathy (2024) Free Book
Bodman MA, Dreyer MA, Varacallo MA. Diabetic Peripheral Neuropathy. [Updated 2024 Feb 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK442009/
Peripheral neuropathy encompasses a broad range of clinical pathologies potentially presenting with peripheral nervous system dysfunction. Patients with peripheral neuropathy often present with varying degrees of numbness, tingling, aching, burning sensation, weakness of limbs, hyperalgesia, allodynia, and pain. Neuropathic pain has been characterized as superficial, deep-seated, or severe, unremitting pain with exacerbation at night. While metabolic disorders represent the predominant etiology of extremity pain caused by an underlying peripheral neuropathy clinical pathology, broad clinical consideration is given to many clinical conditions. There are many possible causes of peripheral neuropathy; the most prevalent subtype, diabetic peripheral neuropathy (DPN), can lead to significant complications ranging from paresthesia to loss of limb and life. Because peripheral neuropathy is so common in patients with diabetes, the American Diabetes Association (ADA) recommends clinicians evaluate patients with type 2 diabetes when they are diagnosed; in patients with type 1 diabetes, clinicians should assess for peripheral neuropathy 5 years after diagnosis and then annually. Peripheral neuropathy is primarily diagnosed clinically. Diabetic peripheral neuropathy management consists of several strategies. The aim of this activity is to enhance healthcare learners’ competence in selecting appropriate diagnostic tests, managing peripheral neuropathy, and fostering effective interprofessional teamwork to improve outcomes. Read more (full article)
* American Diabetes Association (A.D.A.) – Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy (2022) Free Book
Pop-Busui R, Ang L, Boulton AJM, et al. Diagnosis and Treatment of Painful Diabetic Peripheral Neuropathy. Arlington (VA): American Diabetes Association; 2022 Feb. Available from: https://www.ncbi.nlm.nih.gov/books/NBK580224/ doi: 10.2337/db2022-01
Diabetic neuropathies are the most common chronic complications of diabetes, with an estimated lifetime prevalence exceeding 50% in people with diabetes. Among various forms of neuropathy, diabetic peripheral neuropathy (DPN) is the most common and has the strongest evidence base regarding therapeutic approaches. This American Diabetes Association clinical compendium summarizes the latest information about screening for, diagnosing, and treating painful DPN in routine clinical practice. It opens with an overview of the epidemiology of DPN, followed by a description of the pathophysiology of the disease and its often severely painful symptoms. The authors recommend a stepwise approach to effectively diagnose DPN and offer a novel perspective on the impact of social determinants of health on the development and management of DPN. They summarizes the latest guidance on effective therapies, including pharmacological oral and topical agents, nutraceutical products, and nonpharmacological therapies, including physical activity and dietary interventions, passive modalities, and energy or nerve stimulation techniques. Throughout the publication, the authors identify knowledge gaps that need to be addressed and advocate a personalized care approach to reduce the burden of painful DPN and optimize quality of life for individuals affected by it. Read more (full article)
* Diabetologia (EASD) – Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management Open Access
Eleftheriadou, A., Spallone, V., Tahrani, A.A. et al. Cardiovascular autonomic neuropathy in diabetes: an update with a focus on management. Diabetologia 67, 2611–2625 (2024). https://doi.org/10.1007/s00125-024-06242-0
Cardiovascular autonomic neuropathy (CAN) is an under-recognised yet highly prevalent microvascular complication of diabetes. CAN affects approximately 20% of people with diabetes, with recent studies highlighting the presence of CAN in prediabetes (impaired glucose tolerance and/or impaired fasting glucose), indicating early involvement of the autonomic nervous system. Understanding of the pathophysiology of CAN continues to evolve, with emerging evidence supporting a potential link between lipid metabolites, mitochondrial dysfunction and genetics. Recent advancements, such as streamlining CAN detection through wearable devices and monitoring of heart rate variability, present simplified and cost-effective approaches for early CAN detection. Further research on the optimal use of the extensive data provided by such devices is required. Despite the lack of specific pharmacological interventions targeting the underlying pathophysiology of autonomic neuropathy, several studies have suggested a favourable impact of newer glucose-lowering agents, such as sodium–glucose cotransporter 2 inhibitors and glucagon-like peptide-1 receptor agonists, where there is a wealth of clinical trial data on the prevention of cardiovascular events. This review delves into recent developments in the area of CAN, with emphasis on practical guidance to recognise and manage this underdiagnosed condition, which significantly increases the risk of cardiovascular events and mortality in diabetes. Read more (full article)