DIABETIC NEUROPATHY IN ELDERLY PATIENTS - WHAT CAN BE DONE

The prevalence of diabetes mellitus increases markedly with age. Furth ermore, advancing age is a strong risk factor for diabetic neuropathy, independent of the duration of diabetes mellitus and glycaemic contro l. Several biological changes occurring during the aging process may a ccount for the facilitating effect of age on diabetic neuropathy. Thes e include an increase in the production of advanced glycosylation end- products (AGEs), a defect in the polyol pathway, nerve vascular altera tions and impaired resistances to oxidative stress. The clinical diagn osis of diabetic neuropathy is often difficult in elderly patients. Th e relationship between symptoms and neuropathy and that between neurop athy and diabetes mellitus are more difficult to ascertain in elderly patients due to age-related changes in the peripheral and autonomic ne rvous system and associated diseases frequently encountered in this po pulation. Diagnosis of diabetic neuropathy is based on nerve conductio n studies, vibratory perception threshold determination and assessment of autonomic function. For most of these tests, reference values are markedly influenced by age and their interpretation should use careful ly age-adjusted reference intervals.