ABSTRACT

Diabetic neuropathy (DN) is both a prevalent and a debilitating complication that exacts a profound physical, psychological, and financial toll on the type 1 diabetes mellitus (T1DM) patient. DN is widespread; it afflicts 50% of the patients, 25 years after diagnosis with diabetes (1). DN is a causal factor in the development of foot ulcers, a frequent antecedent to nontraumatic limb amputations (2). DN is not limited to the peripheral nervous system; it also affects the autonomic nervous system, with a frequent loss of normal function in the urogenital, digestive, and cardiac systems (3). The estimated annual U.S. cost arising from diabetes is $132 billion and DN accounts for ∼ $11 billion (www.diabetes.org) (4). This chapter will focus on the two most common forms of DN: diabetic polyneuropathy (DPN) and diabetic autonomic neuropathy (DAN). Classification, pathogenesis, epidemiology, clinical presentation, and treatment will be addressed particularly as it relates to T1DM.