THE NEAR-FUTURE DIRECTION OF RESEARCH AND MEDICAL-CARE OF HUMAN DIABETIC NEUROPATHIES

To improve overall detection, characterization, and treatment of diabe tic neuropathies, it is essential that physicians appreciate that not all neuropathies in diabetic patients are from diabetes mellitus. Inve stigators and physicians should increasingly classify diabetic neuropa thy into clearly defined varieties of diabetic neuropathy and quantify severity by stages and by continuous composite measures. Using these approaches, it will be possible to study onset, course, outcomes, risk factors, and treatment more adequately. These approaches should also be used to characterize and quantitate these complications in medical practice. In the near future, it should be possible to identify indivi dual risk factor profiles for problematic degrees of diabetic polyneur opathy. Specific prevention and treatment of diabetic neuropathies are becoming available. For diabetic polyneuropathy, the main approach wi ll be prevention of total hyperglycemic exposure. Other treatments to minimize the bad effects of chronic hyperglycemia exposure may become available. The recognition that immune mechanism may be implicated in multifocal diabetic neuropathies (lumbosacral plexus neuropathy, trunc al radiculopathy, and oculomotor neuropathy) should lead to more focus ed studies of immune mechanisms involved and of treatment. It seems po ssible that many, perhaps most, upper limb mononeuropathies are preven table by avoidance of repetitive injury.