Diabetic polyneuropathy (DPN) (Latin: polyneuropathia diabetica; synonyms: diabetic neuropathy (DNP); polyneuropathy; ICD-10-GM G63.2: diabetic polyneuropathy) is damage to multiple nerves (polyneuropathy) that develops as a complication of existing diabetes mellitus. Approximately 50% of diabetics develop a polyneuropathy in the course of their disease.
Of all neuropathies, diabetic polyneuropathy accounts for about 30-50 %. Approximately 75% of all polyneuropathies (PNP) are caused by diabetes mellitus and alcohol abuse.
Diabetic neuropathy is divided into (for more information, see “Pathogenesis”/Disease Development):
- Peripheral sensorimotor diabetic polyneuropathy (synonym: diabetic sensorimotor polyneuropathy (DSPN)) – disorders usually occur symmetrically in both legs and/or hands (= distal symmetric polyneuropathy).
- Autonomic diabetic neuropathy (ADN), e.g. cardiovascular autonomic neuropathy (CADN), diabetic gastroparesis (gastric paralysis).
- Focal neuropathy: failures of individual peripheral and radicular nerves, e.g. lumbosacral plexus neuropathy (diabetic amyotrophy), which usually occurs unilaterally and leads to weakness in the leg with muscle wasting
Screening for sensorimotor and/or autonomic diabetic neuropathy should be done:
- In the type 2 diabetic at the time of diagnosis.
- In type 1 diabetics at the latest 5 years after diagnosis.
In more than 20% of diabetics over 50 years of age, clinically manifest polyneuropathies are already present at or shortly after the discovery of the diabetes disease.
The prevalence (disease frequency) of diabetic neuropathy is 8-54% in type 1 diabetics and 13-46% in type 2 diabetics (in Germany).
Course and prognosis: In patients with numerous risk factors for the development of diabetes mellitus, peripheral neuropathy (PNP; collective term for diseases of the peripheral nervous system) may already occur in prediabetic stages. In subclinical neuropathy, i.e. no symptoms or clinical findings are present, quantitative neurophysiological tests are already positive.In one quarter of patients with peripheral sensorimotor diabetic polyneuropathy (synonym: diabetic sensorimotor polyneuropathy, DSPN), it is completely painless. However, chronic painful neuropathy often develops in the course of the disease; painless neuropathy is also possible.In the course of the disease, distally symmetrical PNP occurs in every second diabetic patient, and autonomic PNP in every third patient (see “Symptoms – complaints” below).In the course of the disease, distally symmetrical PNP occurs in every second diabetic patient, and autonomic PNP in every third patient (see “Symptoms – complaints” below). Therapeutically, the focus is on achieving normoglycemia (blood glucose levels within the normal range), including control of vascular risk factors. Diabetic polyneuropathy becomes dangerous when the nerves of the heart are already damaged. Diabetics with polyneuropathy have a higher risk of myocardial infarction (heart attack).Typical complications of diabetic polyneuropathy are diabetic neuropathic foot syndrome with foot ulcer (foot ulcer), Charcot foot (diabetic neuro-osteoarthropathy; see below sequelae), and amputation.
