Chapter 24. Treatment of Diabetic Neuropathy

  1. R. Williams3,
  2. W. Herman4,
  3. A.-L. Kinmonth6 and
  4. N. J. Wareham5
  1. Zachary Simmons1 and
  2. Eva L. Feldman2

Published Online: 9 APR 2003

DOI: 10.1002/0470846585.ch24

The Evidence Base for Diabetes Care

The Evidence Base for Diabetes Care

How to Cite

Simmons, Z. and Feldman, E. L. (2002) Treatment of Diabetic Neuropathy, in The Evidence Base for Diabetes Care (eds R. Williams, W. Herman, A.-L. Kinmonth and N. J. Wareham), John Wiley & Sons, Ltd, Chichester, UK. doi: 10.1002/0470846585.ch24

Editor Information

  1. 3

    Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Road, Leeds LS2 9PL, UK

  2. 4

    Department of Internal Medicine and Epidemiology, 1500 East Medical Center Drive, 3920 Taubman Center, Box 0345, Ann Arbor, MI 48109, USA

  3. 5

    Department of Public Health and Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

  4. 6

    General Practice and Primary Care Research Unit, Dept. of Public Health & Primary Care, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge CB2 2SR, UK

Author Information

  1. 1

    Division of Neurology, Penn State College of Medicine, M.S. Hershey Medical Center, Hershey, PA 17033, USA

  2. 2

    Department of Neurology, University of Michigan Health System, 4414 Kresge III, Box 0588, 200 Zina Pritcher Place, Ann Arbor, MI 48109, USA

Publication History

  1. Published Online: 9 APR 2003
  2. Published Print: 27 AUG 2002

ISBN Information

Print ISBN: 9780471988762

Online ISBN: 9780470846582



  • neuropathy;
  • polyneuropathy;
  • autonomic neuropathy;
  • pain;
  • orthostatic hypotension;
  • gastroparesis;
  • bladder dysfunction;
  • impotence;
  • diabetic amyotrophy;
  • aldose reductase inhibitors


Diabetes is the most common cause of neuropathy in the Western world. Diabetic neuropathies are heterogeneous. The most common clinical presentation is a distal symmetric sensory or sensorimotor polyneuropathy, which appears to be due to metabolic and vascular factors. There are not yet any treatments which have been shown to reverse these neuropathies, although aldose reductase inhibitors look promising. Foot care and control of pain remain the mainstays of management. Presentations of diabetic autonomic neuropathy include cardiovascular, gastrointestinal, and genito-urinary dysfunction, which can be partially controlled with medications. Cranial, limb, and truncal neuropathies may occur singly or in combination in patients with diabetes, adding to the complexity of the neurological presentation. Diabetic amyotrophy is an asymmetric, painful condition which may have an inflammatory or autoimmune basis. The role of immunotherapy in diabetic amyotrophy is being explored, but remains uncertain, in view of the self-limited nature of the condition.