Slovo úvodem - Diabetická neuropatie

prof. MUDr. Zdeněk Ambler, DrSc.

Neurol. praxi, 2012; 13(Suppl.E)  

Diabetes mellitus and neuropathy

prof.MUDr.Zdeněk Ambler, DrSc.

Neurol. praxi, 2012; 13(Suppl.E)  

Diabetes mellitus is a chronic disease that results from an absolute or relative lack of insulin leading to metabolic failure. There are two main types of diabetes: type 1 and type 2 diabetes. The number of people with type 2 diabetes is rising rapidly worldwide. Neuropathy is the common complication of diabetes and it is associated with a wide range of clinical manifestations. The duration of diabetes and glycated hemoglobin levels are the principle risk factors in developing diabetic neuropathy, but cardiovascular risk factors contribute significantly.

Pathophysiology of diabetic neuropathy

MUDr.Rudolf Kotas, Ph.D., prof.MUDr.Zdeněk Ambler, DrSc.

Neurol. praxi, 2012; 13(Suppl.E)  

The pathophysiology of diabetic peripheral neuropathy (DPN) is multifactorial and both vascular factors with impairment of vasa nervorum and metabolic interactions are involved at all stages of DPN. The complex and interrelated effects of hyperglycemia include increased metabolic flux through the polyol pathway with consequent sorbitol and fructose accumulation, reduced myoinositol and sodium-potassium ATPase levels and altered protein kinase C activity. Accumulation of advanced glycation end-products, increased reactive oxygen species, altered omega-6-essential fatty acids metabolism and deficit of neurotrophic factors compromise both endoneurial...

Distal symmetrical diabetic polyneuropathy

MUDr.Radim Mazanec, Ph.D.

Neurol. praxi, 2012; 13(Suppl.E)  

Distal symmetrical diabetic polyneuropathy is a most frequent type of diabetic neuropathy in clinical practice. Prevalence of diabetic neuropathy fluctuates in diabetes mellitus type 1 from 22.7 % to 54 % and in diabetes mellitus type 2 from 32.1 % to 45 %. There is now strong evidence, that main risk factors for development and progression of diabetic peripheral neuropathy are age, duration of diabetes mellitus and traditional cardiovascular risk factors. Severity of diabetic neuropathy is evaluated by different composite scales and scores. The diagnosis of diabetic neuropathy is a diagnosis „per exclusionem“and is necessary to...

Diabetic autonomic neuropathy

doc.MUDr.Silvie Lacigová, Ph.D., MUDr.Jitka Tomešová, MUDr.Jitka Gruberová

Neurol. praxi, 2012; 13(Suppl.E)  

Autonomic neuropathy (AN) is a common although rarely diagnosed diabetes complication. There are several reasons – frequent absence of clear symptoms, complicated and often non-available diagnostics. Therefore AN is often a diagnosis per exclusion after excluding the organic defect of the given organ. The insufficient treatment options of AN are another reason why the AN diagnostics is paid such little attention to. Nevertheless AN is dangerous for patients and cardiovascular autonomic neuropathy (CAN) especially increases their morbidity and mortality. The article gives a brief summary of the diagnostic and treatment options of the complication...

Painful and focal diabetic neuropathy

prof.MUDr.Zdeněk Ambler, DrSc.

Neurol. praxi, 2012; 13(Suppl.E)  

Painful diabetic neuropathy is common and is associated with significant reduction in quality of life. A distal and symmetric peripheral neuropathy is the most frequent form, and small fiber damage is thought to result in painful symptoms. The much less common though well recognized are acute painful and atypical neuropathies. A typical painful neuropathy develops on a background of long-standing chronic hyperglycemia, associated metabolic derangements, and cardiovascular risk factors in a patient with a chronic, symmetrical, length-dependent sensorimotor polyneuropathy. Atypical forms are different in several features. They can have an acute...

Treatment of diabetic neuropathy

prof.MUDr.Josef Bednařík, CSc., prof.MUDr.Zdeněk Ambler, DrSc.

Neurol. praxi, 2012; 13(Suppl.E)  

No current disease-modifying treatments have been shown definitively in randomized clinical trials to reduce or reverse diabetic sensory polyneuropathy, but there are approaches to reduce the severity of diabetic neuropathy. Aggressive glycemic control is considered as principal therapeutic measure to postpone development of neuropathy development and to slow its progression. The risk of neuropathy development is also reduced by optimal management of modifiable cardiovascular risk factors and in prediabetes also by lifestyle interventions leading to weight loss and increased physical activity. Modulators of α2-δ subunit of calcium...