Textbook of diabetic neuropathy / [edited by] F. Arnold Gries ... [and others].

Format:

Book

Contributor:

Gries, F. A. (F. Arnold)

Language:

English

Subjects (All):

Diabetic neuropathies.

Diabetic Neuropathies.

Medical Subjects:

Diabetic Neuropathies.

Physical Description:

xiv, 394 pages : illustrations ; 28 cm

Place of Publication:

Stuttgart ; New York : Thieme, [2003]

Summary:

Until recently, diabetic neuropathy has been a poorly understood and neglected complication of diabetes. The last few years have seen a dramatic increase in the understanding of this complex disorder. Here is the first book to present a systematic review that covers such topics as the structure and function of the nervous system, epidemiology and pathophysiology of diabetic neuropathy, and the clinical features and treatment options. It discusses the available diagnostic tools and strategies, and offers guidelines for the outpatient management of diabetic peripheral neuropathy. The book also covers the clinical, technical, and public health issues associated with neuropathy. Knowledge of diabetic neuropathy has improved dramatically in recent years-it's crucial to be familiar with the most recent clinical research on the disease. Essential reading for all internists, neurologists, endocrinologists, and related specialists who treat patients with diabetes!

Contents:

1 Diabetes Mellitus: An Introduction / F.A. Gries, J. Eckel, P. Rosen, D. Ziegler 1

Diagnosis 1

Classification 2

Epidemiology 2

Type 1 Diabetes/IDDM 2

Type 2 Diabetes/NIDDM 3

Etiology and Pathogenesis of Diabetes 4

Type 1 Diabetes 4

Type 2 Diabetes 5

Clinical Picture of Diabetes Mellitus 9

Acute Symptoms 9

Type 1 Diabetes 10

Type 2 Diabetes 11

Chronic Complications 11

Introduction to the Pathogenesis of Microangiopathy 11

Retinopathy 12

Nephropathy 14

Macroangiopathy 16

Management of Diabetes Mellitus 18

Prevention 18

Treatment 19

Pharmacological Treatment of Type 1 Diabetes 22

Pharmacological Treatment of Type 2 Diabetes 24

2 Structure and Function of the Nervous System 40

The Somatic Nervous System / N. E. Cameron 40

Central Nervous System Pathways 40

Peripheral Nerve, Receptors, and Spinal Cord 43

Vascular Supply in the Peripheral Somatic Nervous System 49

The Autonomic Nervous System / C.J. Mathias 51

Basic Principles 51

Assessing Autonomic Activity 55

Investigation of Autonomic Function 55

Evaluation of Central Autonomic Activity and Function 56

Additional Nonautonomic Investigations 60

3 Epidemiology of Diabetic Neuropathy / J. E. Shaw, P.Z. Zimmet, F. A. Gries, D. Ziegler 64

Testing for Peripheral Neuropathy 64

Population Selection 65

How Common Is Diabetic Neuropathy? 66

Distal Symmetrical Polyneuropathy 66

Focal and Multifocal Neuropathies 70

Cardiovascular Autonomic Neuropathy 70

Gastrointestinal Neuropathy 72

Erectile Dysfunction 72

Etiological Factors Related to Diabetic Neuropathy 73

Hyperglycemia 74

Diabetes Duration 74

Age 75

Hypertension 75

Hypoinsulinemia 75

Hyperinsulinemia 75

Other Risk Factors 76

Genetic Factors 76

Prognosis 77

Distal Symmetrical Polyneuropathy 77

Cardiovascular Autonomic Neuropathy 77

4 Pathogenesis and Pathology of Diabetic Neuropathy 83

Histopathology 83

Diabetic Peripheral Neuropathy / A.P. Mizisin, H.C. Powell 83

Hyperglycemia-Induced Histopathology 83

Relationship of Histopathology to Type of Diabetic Neuropathy 87

Diabetic Autonomic Neuropathy / R.E. Schmidt 87

Neuropathology of Clinical Diabetic Autonomic Neuropathy 87

Experimental Diabetic Autonomic Neuropathy 89

Pathogenetic Mechanisms 91

Pathobiochemistry and Pathophysiology 91

Glycemic Control / D. Ziegler 91

Rapidly Reversible Nerve Dysfunction After Correction of Metabolic Derangement 92

Role of Intensive Diabetes Therapy in Treatment and Prevention of Diabetic Neuropathy 92

Is There a Glycemic Threshold for the Risk of Diabetic Complications? 96

Metabolic Alterations in Experimental Models / A.A.F. Sima, C.R. Pierson 96

The Polyol Pathway and the Na+, K+-ATPase Defect 97

Role of Nonenzymatic Glycation 98

Role of Oxidative Stress and Alterations in Blood Flow 99

Role of Essential Fatty Acids 100

Role of Neurotrophic Factors 100

Neuropathy Associated with Hyperinsulinemia and Hypoglycemia 101

Physiologic Role of Proinsulin C-Peptide 102

Relationships Between Metabolic Alterations and Structural Pathology in Type 1 and Type 2 Diabetic Neuropathy 102

Future Directions 105

Glycation and Advanced Glycation Reactions / J.W. Baynes 105

Maillard Reaction Products 106

Diabetic Neuropathy 109

Polyolpathway: Aldose Reductase Inhibitors

Hope for the Future? / E.L. Feldman, K.A. Sullivan, M.J. Stevens 112

Pathophysiology 112

Therapy 113

Nerve Blood Flow / M.A. Cotter, A. Veves, S. Tesfaye, N.E. Cameron 115

Nerve Blood Flow in Diabetic Patients 115

Nerve Axon Reflex 118

Blood Vessel Morphology in Diabetic Nerves 119

Treatments to Test the Vascular Hypothesis in Peripheral Diabetic Neuropathy 119

Importance of Neuron Cell Bodies 122

Oxidative Stress: An Integrative View / P.A. Low 123

Presence of Oxidative Stress in Human and Experimental Diabetes 123

Free Radical Defenses Are Reduced in Peripheral Nerve 124

Reduced Oxygen Species Are Increased in experimental diabetic neuropathy 125

Changes in Pro-oxidant Status 127

Neural Targets of Oxidant Stress 127

Synthesis of Pathogenetic Hypothesis 127

Neurotrophic Factors / A. Vinik, G. Pittenger, K. Stansberry, T.S. Park, T. Erbas, M. Skeen 129

Insulin and IGFs as Neurotrophic Factors 134

Neuroimmunophilins 140

Programmed Cell Death and Neuropathy 140

Glutamate Neurotoxicity and Its Prevention 141

NAAGS in Diabetic Neuropathy 142

Therapeutic Potential for Growth Factors 142

Caveats on the Use of Neurotrophic Factors in the Clinic 143

Autoimmunity / P.J. Watkins, G. Sundkvist 144

Autoimmunity and the Nervous System 144

5 Clinical Features and Treatment of Diabetic Neuropathy 170

Severity and Staging of Diabetic Polyneuropathy / P.J. Dyck 170

Why Quantitate the Severity of Diabetic Polyneuropathy? 170

How Is Severity of Diabetic Polyneuropathy to Be Judged? 170

Minimum Criteria for the Diagnosis of Diabetic Neuropathy 170

Can Neuropathic Abnormalities Be Demonstrated in Patients Who Do not Fulfill Minimum Criteria for Diabetic Polyneuropathy? 171

Severity of Neuropathic Symptoms 171

Continuous Measures of Neuropathic Impairment 172

Composite Scores for Diabetic Polyneuropathy Severity 172

Staging Severity of Diabetic Polyneuropathy 174

Classification of the Diabetic Neuropathies / P.K. Thomas 175

Hyperglycemic Neuropathy 175

Diabetic Distal Sensory or Sensorimotor Polyneuropathy 176

Acute Painful Diabetic Neuropathy 176

Autonomic Neuropathy 176

Acute Motor Neuropathy 176

Focal and Multifocal Neuropathies 176

Cranial Neuropathies 176

Thoracolumbar Radiculoneuropathy 176

Proximal Diabetic Neuropathy 177

Focal Limb Nerve Lesions 177

Superimposed Chronic Inflammatory Demyelinating Polyneuropathy 177

Hypoglycemic Neuropathy 177

Diabetic Sensorimotor Neuropathy: Methods of Assessment 177

Electrophysiologic Testing / V. Bril 177

Introduction to Electrophysiology 177

Nerve Conduction Studies in Neuropathies: An Overview 178

Axonal Neuropathies: Diabetic Neuropathy as the Prototype 178

Methodology 181

Limitations 184

Quantitative Sensory Testing / J.C. Arezzo 184

Pathophysiology Underlying the Elevation of Sensory Thresholds 185

Methodology 186

Vibration Perception Threshold 187

Thermal Perception Threshold 188

Simple Devices 188

Epidemiologic Studies and Multicenter Clinical Trials 189

Limitations of QST in the Assessment of Diabetic Neuropathy 189

Motor Function / H. Andersen, J. Jakobsen 189

Muscle Strength 190

Visualization and Quantification of Striated Muscle 193

Unmyelinated Nerves: Skin Biopsy and Skin Blister Methods / W.R. Kennedy, G. Wendelschafer-Crabb 194

Biopsy/Blister Procedures, Staining, and Imaging 195

Quantitation of Nerves in a Skin Biopsy and Blister 197

Cutaneous Nerves in Diabetic Neuropathy 197

Advantages of Skin Biopsy/Blister Methods 197

When and Where to Biopsy/Blister 198

ENF Density and Sensation 198

Diabetic Sensorimotor Neuropathy: Clinical Features 199

Symmetric Distal Polyneuropathy / B. Neundorfer, P.K. Thomas 199

Clinical Picture 199

Differential Diagnosis 201

Focal and Multifocal Neuropathies / P.K. Thomas 202

Cranial Neuropathies 202

Diabetic Truncal Radiculoneuropathy 203

Lumbosacral Radiculoplexus Neuropathy 203

Focal or Multifocal Limb Neuropathies 204

Treatment 204

Central Diabetic Neuropathy / G.J. Biessels, W.H.

Gispen 205

Cognitive Functioning 205

Type 1 Diabetes 205

Type 2 Diabetes 205

Diabetes, Hyperinsulinemia, and Impaired Glucose Tolerance in the Elderly 205

Neurophysiologic Findings 206

Evoked Potentials 206

Event-Related Potentials 206

Structural Cerebral Changes 206

Pathobiochemistry 206

Links with Peripheral Neuropathy 207

Interaction with Brain Aging 207

Cerebrovascular Alterations 207

Clinical Management 207

Diabetic Sensorimotor Neuropathy: Treatment 208

Mechanisms of Neuropathic Pain / P.K. Thomas 208

Pain in Distal Focal or Multifocal Diabetic Neuropathy 208

Pain in Diabetic Polyneuropathy 208

Mechanisms of Pain in Diabetic Neuropathy 208

Nerve Trunk Pain 209

Dysesthetic Pain 209

Peripheral Blood Flow 210

Glycemic Control 210

CNS Change Secondary to Damage to the Peripheral Nervous System 210

Treatment of Neuropathic Pain / D. Ziegler 211

Neuropathic Pain 211

Clinical Features of Painful Diabetic Neuropathies 212

Diffuse Polyneuropathies 212

Measures of Neuropathic Pain 213

Treatment of Painful Diabetic Neuropathy 214

Symptomatic Nonpharmacologic Treatment 224

Diabetic Autonomic Neuropathy 225

Cardiovascular System / V. Spallone, G. Menzinger, D. Ziegler 225

Epidemiology, Risk Factors, and Prognosis 225

Clinical Features 225

Assessment 228

Clinical Impact 240

Respiratory Tract / L. Scionti, P. Bottini 241

Abnormalities of Respiration 242

Gastrointestinal Tract / D. O'Donovan, M. Samson, C. Feinle, K.L. Jones, M. Horowitz 246

Pathophysiology of Disordered Gut Motility 246

Impact of Gastrointestinal Motility on Glycemic Control 247

Gastrointestinal Symptoms 248

Urogenital System / C.G. Stief, D. Ziegler 262

Erectile Dysfunction 263

Oral Agents 268

Local Pharmacotherapy 271

Vacuum Devices 272

Penile Reconstructive Surgery 272

Prosthetic Surgery 272

Bladder Dysfunction 272

Sudomotor Function / P.A. Low 274

Normal Sweat Response 274

Tests of Sudomotor Function 275

Pupillary Function / R.H. Straub 278

Anatomy and Physiology 278

Pupillary Autonomic Dysfunction in Diabetic Neuropathy 282

Endocrine Regulation in Response to Physiologic Maneuvers / J. Hilsted, M. Taskiran 283

Physical Exercise 283

Orthostatic Hypotension 285

Treatment 286

Response to Hypoglycemia / G.B. Bolli, C.G. Fanelli, F. Porcellati, S. Pampanelli 286

Physiology of Responses to Hypoglycemia 287

Definition of Hypoglycemia 287

Pathophysiology of Hypoglycemia in Type 1 Diabetes 287

Role of Recurrent Preceding Hypoglycemia in Responses to Hypoglycemia in Diabetic Autonomic Neuropathy 290

Contribution of Diabetic Autonomic Neuropathy Per Se to Reduced Plasma Epinephrine Responses to Hypoglycemia in Type 1 Diabetes 293

The Diabetic Foot / A.J.M. Boulton 296

Epidemiology and Economic Aspects 296

Etiopathogenesis of Diabetic Foot Lesions 297

Sensorimotor Neuropathy 297

Autonomic Neuropathy 297

Other Risk Factors 297

Pathway to Ulceration 298

Complex Causality 298

The Patient with Sensory Loss 299

Prevention of Diabetic Foot Ulcers 300

Screening 300

Semmes-Weinstein Monofilaments 300

Vibration Perception Threshold and Thermal Threshold 300

Interventions for High Risk Patients 300

Education 300

Podiatry/Chiropody 301

Footwear/Orthoses/Hosiery 301

Silicone 301

Diabetic Charcot Neuroarthropathy 301

Foot Ulcers: Diagnosis and Management 303

Foot Ulcer Classification 303

Wound Healing in Diabetes 304

Off-Loading 304

Dressings 305

Management of Infection 305

Other Therapies 307

Prediction of Outcome 307

The Team Approach 308

Special Syndromes 308

Insulin, Hypoglycemia, and Peripheral Neuropathy / S.E.M. Eaton, S. Tesfaye 308

Hypoglycemic Neuropathy 308

Insulin Neuritis (Acute Painful Neuropathy of Rapid Glycemic Control) 310

Implications for Diabetic Neuropathy 312

Ketosis-Related Neuropathy / R.A. Malik 312

Diabetic Ketoacidosis-Associated Neuropathy 312

Models of Ketoacidotic Neuropathy 314

Diabetic Acute Motor Neuropathy / P.A. Low 315

Acute or Subacute Distal Motor Neuropathy 315

Diabetic Proximal Motor Neuropathy 315

Diabetic Motor Mononeuropathies 315

Evaluation of Drug Effects / D. Luft, D. Ziegler 315

Classification, Diagnosis, and Staging 316

Relevant Outcome Measures in Controlled Clinical Trials 317

Problems Related to the Use of Surrogate Variables 317

Clinical Measures 318

Electrodiagnostic Measures 318

Quantitative Sensory Testing 319

Morphologic Analysis 319

Autonomic Function Tests 319

Symptomatic Pain Treatment 319

Natural History 319

Sample Size and Duration of Trials 320

Reproducibility 321

Factors Confounding Treatment Effects 323

Measures of Relevant Treatment Effects 324

Definitions of Clinically Relevant Treatment Effects 324

Presentation of Treatment Effects 324

Statistical Evaluation of RCTs 326

Reporting of RCTs 327

Problems of Meta-analysis of Trials for the Treatment of Diabetic Neuropathy 327

External Validity of RCT Results 328

6 Socioeconomic Aspects / W. Rathmann, J. Ward 361

Direct Costs of Diabetic Neuropathy 361

Costs of Medical Care For Diabetic Neuropathy 361

Costs of Medication 361

Potential Cost Savings by Prevention of Diabetic Neuropathy 362

Methodologic Considerations 362

Costs of Foot Ulcer and Lower-Extremity Amputation 362

Cost-of-Illness Studies: Data Sources 363

Center-Based Studies 363

Databases (Health Insurance Companies) 363

Hospital-Based Studies 365

Further Studies on Costs of Diabetic Foot Complications 366

Economic Modeling: Benefits of Prevention 367

Cost-Effective Treatment of Diabetic Foot Ulcers 367

Indirect Consequences: Disability and Premature Death 368

Socioeconomic Status, Diabetic Neuropathy, and Foot Ulcer 368

Health-Related Quality of Life and Diabetic Neuropathy 369

Quality of Life and Peripheral Neuropathy 369

Quality of Life, Foot Ulcer, and Amputation 370

Psychological Aspects of Preventive Care 370

Burden to the Patient 370

7 Recommendations for Structured Care / F.A. Gries, P.A. Low, D. Ziegler 373

Outpatient Diabetes Care 373

Screening and Early Detection of Diabetic Neuropathy 374

Outpatient Care of Diabetic Neuropathy 374

Guidelines for the Diagnosis and Outpatient Management of Diabetic Peripheral Neuropathy / AJM Boulton, F.A. Gries, J.A. Jervell 378

Assessment as Part of the Annual Review of the Patient 378

Management 379

Appendix 1 International Guide on the Outpatient Management of Diabetic Peripheral Neuropathy 379

Peripheral Neuropathy in Diabetes 380

Stages of Neuropathy 381

Assessment 381

Patient History 381

Examination of the Patient 382

Other Investigations 382

The "At Risk" Foot 382

Management 382

No Clinical Neuropathy (Stage 0/1) 383

Clinical Neuropathy (Stage 2) 383

Late Complications of Clinical Neuropathy (Stage 3) 383

Patient Education 384

Who Should Provide Patient Education? 384

What methods should be used? 384

What elements should the education programme contain? 384

Summary of the Management of Neuropathy 385

Pilot Working Party, Brussels, Belgium 13 April 1995 385

Full Working Party, London, UK, 20-22 October 1995 385.

Notes:

Includes bibliographical references and index.

ISBN:

3131275812

1588900053

OCLC:

51958381