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Epidemiology and classification of diabetic neuropathy

Eva L Feldman, MD, PhD
Section Editor
Jeremy M Shefner, MD, PhD
Deputy Editor
John F Dashe, MD, PhD


Involvement of the peripheral and autonomic nervous systems is probably the most common complication of diabetes. Clinical diabetic neuropathy is categorized into distinct syndromes according to the neurologic distribution, although many overlap syndromes occur. In both type 1 and type 2 diabetes, the prevalence varies with both the severity and duration of hyperglycemia.

This topic will review the epidemiology and classification of diabetic neuropathy. Other aspects of diabetic neuropathy are discussed separately. (See "Pathogenesis and prevention of diabetic polyneuropathy" and "Clinical manifestations and diagnosis of diabetic polyneuropathy" and "Diabetic autonomic neuropathy" and "Treatment of diabetic neuropathy" and "Diabetic amyotrophy and idiopathic lumbosacral radiculoplexus neuropathy".)


Diabetic polyneuropathy is the most common neuropathy in the Western world [1]. Clinical and subclinical neuropathy has been estimated to occur in 10 to 100 percent of diabetic patients, depending upon the diagnostic criteria and patient populations examined. Prevalence is a function of disease duration, and a reasonable figure, based upon several large studies, is that approximately 50 percent of patients with diabetes will eventually develop neuropathy [1-3].

The prevalence and incidence of diabetic polyneuropathy can be illustrated by the following observations:

In a landmark study, over 4400 patient with diabetes were serially evaluated over 25 years [4-6]. Neuropathy was defined as decreased sensation in the feet and depressed or absent ankle reflexes. The onset of neuropathy correlated positively with the duration of diabetes and, by 25 years, 50 percent of patients had neuropathy.

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Literature review current through: Nov 2017. | This topic last updated: Dec 15, 2016.
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  1. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology 1993; 43:817.
  2. Dyck PJ, Litchy WJ, Lehman KA, et al. Variables influencing neuropathic endpoints: the Rochester Diabetic Neuropathy Study of Healthy Subjects. Neurology 1995; 45:1115.
  3. Edwards JL, Vincent AM, Cheng HT, Feldman EL. Diabetic neuropathy: mechanisms to management. Pharmacol Ther 2008; 120:1.
  4. Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (author's transl)]. Diabete Metab 1977; 3:97.
  5. Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (2nd part) (author's transl)]. Diabete Metab 1977; 3:173.
  6. Pirart J. [Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author's transl)]. Diabete Metab 1977; 3:245.
  7. Abbott CA, Malik RA, van Ross ER, et al. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care 2011; 34:2220.
  8. Young MJ, Boulton AJ, MacLeod AF, et al. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 1993; 36:150.
  9. Sands ML, Shetterly SM, Franklin GM, Hamman RF. Incidence of distal symmetric (sensory) neuropathy in NIDDM. The San Luis Valley Diabetes Study. Diabetes Care 1997; 20:322.
  10. Forrest KY, Maser RE, Pambianco G, et al. Hypertension as a risk factor for diabetic neuropathy: a prospective study. Diabetes 1997; 46:665.
  11. Jaiswal M, Lauer A, Martin CL, et al. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36:3903.
  12. Humphrey LL, Palumbo PJ, Butters MA, et al. The contribution of non-insulin-dependent diabetes to lower-extremity amputation in the community. Arch Intern Med 1994; 154:885.
  13. Bastron JA, Thomas JE. Diabetic polyradiculopathy: clinical and electromyographic findings in 105 patients. Mayo Clin Proc 1981; 56:725.
  14. Kikta DG, Breuer AC, Wilbourn AJ. Thoracic root pain in diabetes: the spectrum of clinical and electromyographic findings. Ann Neurol 1982; 11:80.
  15. Ellenberg M. Diabetic neuropathic cachexia. Diabetes 1974; 23:418.
  16. Neal JM. Diabetic neuropathic cachexia: a rare manifestation of diabetic neuropathy. South Med J 2009; 102:327.
  17. Castellanos F, Mascias J, Zabala JA, et al. Acute painful diabetic neuropathy following severe weight loss. Muscle Nerve 1996; 19:463.
  18. Brown MR, Dyck PJ, McClearn GE, et al. Central and peripheral nervous system complications. Diabetes 1982; 31:65.
  19. Pecket P, Schattner A. Concurrent Bell's palsy and diabetes mellitus: a diabetic mononeuropathy? J Neurol Neurosurg Psychiatry 1982; 45:652.
  20. Adour K, Wingerd J, Doty HE. Prevalence of concurrent diabetes mellitus and idiopathic facial paralysis (Bell's palsy). Diabetes 1975; 24:449.
  21. Steel JM, Young RJ, Lloyd GG, Clarke BF. Clinically apparent eating disorders in young diabetic women: associations with painful neuropathy and other complications. Br Med J (Clin Res Ed) 1987; 294:859.
  22. Tesfaye S, Malik R, Harris N, et al. Arterio-venous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). Diabetologia 1996; 39:329.
  23. Dabby R, Sadeh M, Lampl Y, et al. Acute painful neuropathy induced by rapid correction of serum glucose levels in diabetic patients. Biomed Pharmacother 2009; 63:707.
  24. Gibbons CH, Freeman R. Treatment-induced diabetic neuropathy: a reversible painful autonomic neuropathy. Ann Neurol 2010; 67:534.
  25. Gibbons CH, Freeman R. Treatment-induced neuropathy of diabetes: an acute, iatrogenic complication of diabetes. Brain 2015; 138:43.
  26. Honma H, Podratz JL, Windebank AJ. Acute glucose deprivation leads to apoptosis in a cell model of acute diabetic neuropathy. J Peripher Nerv Syst 2003; 8:65.
  27. Ohshima J, Nukada H. Hypoglycaemic neuropathy: microvascular changes due to recurrent hypoglycaemic episodes in rat sciatic nerve. Brain Res 2002; 947:84.