Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Diabetic POLYNEUROPATHY

2,975 views

Published on

TREATMENT OF DIABETIC POLYNEUROPATHY

Published in: Health & Medicine
  • Login to see the comments

Diabetic POLYNEUROPATHY

  1. 1. Diabetic Neuropathy
  2. 2. Diabetic Neuropathy by Prof Ashraf Abdou Neuropsychiatry dept. Alexandria Univ.
  3. 3. Definition of diabetic neuropathy Epidemiology Pathogenesis. Clinical presentations. Management. Session Objectives:
  4. 4. Definition “The presence of signs and/or symptoms of peripheral nerve dysfunction in diabetic patient after exclusion of other causes.” 6Boulton AJ, Gries FA, Jervell JA: Guidelines for the diagnosis and outpatient management of diabetic peripheral neuropathy. Diabet Med 15:508–514, 1998
  5. 5. Peripheral NERVES Cranial Peripheral Autonomic Motor Sensory
  6. 6. Peripheral NERVES
  7. 7. Epidemiology 50% of patients who have diabetes for >25 yrs (Pirart. Diabetes Care 1978) Late in type 1, may be 1st presentation of type 2 DM 50% are painful neuropathy
  8. 8. Pathogenesis Metabolic Vascular
  9. 9. Risk factors Duration of diabetes Control of diabetes  Hyperlipaedemia  Overweight  Smoking  Alcohol  Old age
  10. 10. ‫ررر‬ ‫ررر‬ ‫رررر‬‫ررر‬ ‫ررر‬ ‫رررر‬19301930
  11. 11. Clinical presentations Diffuse neuropathy Symmetric sensorimotor polyneuropathy Autonomic neuropathy Focal neuropathy  Cranial neuropathy  Plexopathy  Polyradiculopathy  Mononeuropathy
  12. 12. Peripheral sensori-motor neuropathy  Distal, bilateral,symmetrical, stocking-glove distribution.  Symptoms range from numbness (“deadness”) to severe pain. Burning, alteration of temperature sensation, parathesias, shooting, or stabbing pains are common.  May worsen at night.  Minor motor involvement causing weakness.
  13. 13. Peripheral sensori-motor neuropathy (cont.) Decrease or absent reflexes Loss or diminished vibratory sensation (128Hz tuning fork), pin prick, light touch, or pressure perception Muscle atrophy Foot complications, ulcerations, blisters, deformities (Charcot’s joint)
  14. 14. Autonomic neuropathy Affects the autonomic nerves controlling internal organs  Peripheral  Genitourinary  Gastrointestinal  Cardiovascular Is classified as clinical or subclinical based on the presence or absence of symptoms
  15. 15. Peripheral Autonomic Dysfunction Contributes to the following symptoms/signs: Neuropathic arthropathy (Charcot foot) Aching, pulsation, tightness, cramping, dry skin, pruritus, edema, sweating abnormalities Weakening of the bones in the foot leading to fractures
  16. 16. Genitourinary Autonomic Neuropathy Sign/Symptom Treatment Bladder dysfunction Voluntary urination; catheterization Retrograde ejaculation Antihistamine Erectile dysfunction Sildenafil, tadalafil Dyspareunia Lubricants; estrogen creams
  17. 17. Gastrointestinal Autonomic Neuropathy Symptoms/Signs Gastroparesis resulting in anorexia, nausea, vomiting, and early satiety Diabetic enteropathy resulting in diarrhea and constipation
  18. 18. Cardiovascular Autonomic Neuropathy Symptoms/Signs Exercise intolerance Postural hypotension
  19. 19. TREATMENTTREATMENT
  20. 20. ‫للللل‬ ‫لللل‬1930
  21. 21. Treatment Based on pathogenesis Symptomatic
  22. 22. Based on Pathogenesis Compound Status of RCTs alpha- lipoic acid Effective in RCTs Vasodilators Effective in 1 trial ACE inhibitor Effective in 1 trial Protein kinase inhib Ongoing NGF Ineffective
  23. 23. Symptomatic
  24. 24. Symptomatic Analgesics  Antidepressant s Antiepileptic s  Antiarrhythmic s.
  25. 25. Symptomatic treatment Antidepressants Compound Dose NNT TCAs; oAmitriptyline oimipramine 100 -150mg 2.1 Venlafaxine 150 – 275mg 5.5 Duloxetine 60 – 120mg 4
  26. 26. Symptomatic treatment Antiepileptics Compound Dose NNT Carbamazepine 600mg 2.3 Gabapentin 2400 – 3600mg 3.9 Pregabalin 300 – 600 mg 4.2
  27. 27. Symptomatic treatment Other agents Compound Dose NNT Capsaicin cream 6.7 Tramadol 200 – 400mg 3.5 Mexilitine 400 – 600mg 2.2
  28. 28. FDA approved: •Pregabalin •Duloxetine
  29. 29. Diabetic neuropathy OR Neuropathy in diabetic patient ? Chronic inflammatory demyelinating polyneuropathy B12 deficiency Uremia Hypothyroidism Monoclonal gamopathies 1/3 of diabetics have neuropathy unrelated to diabetes
  30. 30. Diabetic neuropathy OR Neuropathy in diabetic patient ? o Rapidly progressive o Prominent motor o Cranial nerves o Predominant large fiber
  31. 31. Summary Diabetic neuropathy is common [up to 40-50% over a 10-25 year span] Tight control can prevent neuropathy Once a patient develops neuropathy, there are few treatments proven to be effective Foot care is essential in preventing neuropathic complications Neuropathy in diabetic patient may be caused by other etiologies

×