Symposium 7: Peripheral neuropathy SY7.1. Inflammatory neuropathies and diabetes

Abstract

Inflammatory neuropathies may occur with diverse presentations in subjects with diabetes. Separating these neuropathies from typical diabetic polyneuropathy is important as prognosis and treatment differ. Diabetic lumbosacral radiculoplexus neuropathy and diabetic cervical radiculoplexus neuropathy are common and need to be readily recognized as require pain relief but no immunotherapy, and as are of generally good prognosis. Prompt diagnosis is important in vasculitic neuropathy in diabetes which requires similar diagnostic and treatment strategies as in non-diabetic subjects. Chronic inflammatory demyelinating polyneuropathy (CIDP) in diabetes has been the subject of controversy and uncertainty in recent years with divergent results from different non-population based and epidemiological studies. Some suggested an increased risk of CIDP with diabetes, while others did not. The clinical features take priority when considering CIDP in diabetic patients. Electrophysiology, although helpful for diagnostic confirmation, may however in practice pose problems with regards to technique and interpretation. This may result both in under- and overdiagnosis of CIDP in subjects with underlying diabetic polyneuropathy. Recent studies from different the U.K., Serbia and Italy, of 650 subjects with “definite” or “probable” CIDP, appear to confirm a higher prevalence of diabetes in CIDP populations, which is of later onset compared to subjects without diabetes. Data from these recent studies also suggest typical CIDP may be the predominant form in diabetic subjects, with however persistent uncertainty remaining with regards to disability levels and treatment response compared to subjects without diabetes. This implies that treatment strategies for subjects with CIDP and diabetes should not differ from those in subjects without diabetes, except for precautionary measures with regards diabetic control and vascular risk.