PERIPHERAL NEUROPATHIES IN DIABETES

Peripheral neuropathies can be a source of great morbidity and discomf ort to diabetic patients and a challenge for the physician. The clinic al manifestations of specific peripheral neuropathies, such as small- and large-fiber sensory neuropathies, autonomic and motor neuropathies , mixed polyneuropathies, and focal compression neuropathies are revie wed. The pathophysiology involves several potential mechanisms, includ ing ischemic, metabolic, and immune-mediated pathways. Electrophysiolo gic testing, peripheral nerve biopsies, and skin biopsies are modaliti es that aid in diagnosis. Treatment emphasizes preventive foot care, s trict blood glucose control and symptomatic control of painful neuropa thies. Newer modalities of treatment, including pancreatic transplants and several new drugs, can block and potentially reverse the patholog ic process of peripheral neuropathies in patients with diabetes.