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Peripheral Neuropathy Research Center, Department of Neurology (K.M. Kratz, J.L. Karnes, and Drs. Dyck and Litchy), the Department of Internal Medicine, Division of Nephrology (Dr. Wilson), the Department of Ophthalmology (Dr. Pach), the Section of Biostatistics (Dr. O'Brien), and the Section of Clinical Epidemiology (Dr. Melton), Mayo Clinic and Mayo Foundation, Rochester, MN; and the Department of Ophthalmology and Center for Biostatistics (Dr. Klein), University of Wisconsin, Madison, WI.
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. Overall, two thirds of diabetic patients have objective evidence for some variety of neuropathy, but only about 20% have symptoms, and only 6% of IDDM and only 1% of NIDDM patients have sufficiently severe polyneuropathy to be graded stage 2b, and none were graded stage 3. Approximately one quarter of patients had subclinical carpal tunnel syndrome, but only 7.7% had symptomatic carpal tunnel syndrome. Thus, diabetic peripheral neuropathy is frequent but less severe than generally thought. As generally believed, however, neuropathy, retinopathy, and nephropathy are significantly associated.
Address correspondence and reprint requests to Dr. Peter James Dyck, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Received June 10, 1992. Accepted for publication in final form August 4, 1992.
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S. Tesfaye Diabetic neuropathy: achieving best practice The British Journal of Diabetes & Vascular Disease, March 1, 2003; 3(2): 112 - 117. [Abstract] [PDF]
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M. Kirby Painful diabetic neuropathy -- current understanding and management for the primary care team The British Journal of Diabetes & Vascular Disease, March 1, 2003; 3(2): 138 - 144. [Abstract] [PDF]
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B. Gaster and I. B. Hirsch The Effects of Improved Glycemic Control on Complications in Type 2 Diabetes Arch Intern Med, January 26, 1998; 158(2): 134 - 140. [Abstract] [Full Text] [PDF]
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The Diabetes Control and Complications Trial Resea Lifetime Benefits and Costs of Intensive Therapy as Practiced in the Diabetes Control and Complications Trial JAMA, November 6, 1996; 276(17): 1409 - 1415. [Abstract] [PDF]
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