ABSTRACT
It is estimated that 16 million people in the United States have diabetes. The frequency of neuropathy in this group depends on the method used to define neuropathy (i.e., symptoms, clinical signs, electrophysiology, nerve pathology, or a combination). Pirart reported from his large study of 4400 patients that the prevalence of polyneuropathy was 8% in diabetics at the time of diagnosis (1). This percentage rose to approximately 40% after 20 years and 50% at 25 years (1). Pirart defined neuropathy for his study as the loss of Achilles or knee reflexes or both and diminished vibration perception. Neuropathy occurs in the same frequency in type I and II diabetes. Little objective data are known about the effect of neuropathy on morbidity and mortality. Yet, anyone with experience caring for patients with diabetic neuropathy can attest to the severe morbidity that arises from their deficits of weakness, pain, paresthesias, imbalance, and autonomic dysfunction.
