Diabetic neuropathy: achieving best practice

Peripheral neuropathy is one of the commonest complica-tions of diabetes and the commonest form of neuropathyin the developed world.1 Diabetic polyneuropathy encom-passes several neuropathic syndromes, and the commonest pre-sentation is chronic distal symmetrical neuropathy (DSP). DSP, often associated with autonomic neuropathy, has two clinical consequences: namely neuropathic pain and foot ulceration. Both often occur in the same individual, and cause severe cur-tailment of quality of life. The other, less common presentations of diabetic polyneuropathy include acute painful neuropathies, and focal neuropathies (amyotrophy, pressure palsies, truncal radiculopathies, mononeuropathies and mononeuritis multi-plex).2 Table 1 shows a recent classification of diabetic polyneu-ropathy based upon the natural history of the various syn-dromes.3 Br J Diabetes Vasc Dis 2003;3:112–1