Diagnosis, classification, and treatment of diabetic peripheral neuropathy.

Neuropathy is one of the most common long-term complications of diabetes. Sensorimotor polyneuropathy first affects the more distal parts of the lower extremities and then spreads more centrally and is therefore the most commonly involved in diabetic foot problems. Autonomic neuropathy causes increased arteriovenous shunting and tissue hypoxia at the feet but also involves other systems, such as the gastrointestinal, cardiovascular, and genitourinary systems. More than one factor is believed to be involved in its pathogenesis. Good glycemic control can prevent the development of the disease or halt its progression. Other therapeutic factors, currently under investigation in a large clinical trial, include aldose reductase inhibitors and gammalinolenic acid with promising results so far.