Читать книгу Diabetic Neuropathy - Friedrich A. Gries - Страница 6
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1 Diabetes Mellitus: An Introduction
F.A. Gries, J. Eckel, P. Rösen, and D. Ziegler
Etiology and Pathogenesis of Diabetes
Clinical Picture of Diabetes Mellitus
Introduction to the Pathogenesis of Microangiopathy
Management of Diabetes Mellitus
Pharmacological Treatment of Type 1 Diabetes
Pharmacological Treatment of Type 2 Diabetes
2 Structure and Function of the Nervous System
N. E. Cameron
Central Nervous System Pathways
Peripheral Nerve, Receptors, and Spinal Cord
Vascular Supply in the Peripheral Somatic Nervous System
C.J. Mathias
Investigation of Autonomic Function
Evaluation of Central Autonomic Activity and Function
Additional Nonautonomic Investigations
3 Epidemiology of Diabetic Neuropathy
J.E. Shaw. P.Z. Zimmet. F.A. Cries. And D. Ziegler
Testing for Peripheral Neuropathy
How Common Is Diabetic Neuropathy?
Distal Symmetrical Polyneuropathy
Focal and Multifocal Neuropathies
Cardiovascular Autonomic Neuropathy
Etiological Factors Related to Diabetic Neuropathy
Hyperglycemia
Distal Symmetrical Polyneuropathy
Cardiovascular Autonomic Neuropathy
4 Pathogenesis and Pathology of Diabetic Neuropathy
Diabetic Peripheral Neuropathy
A.P. Mizisin and H.C. Powell
Hyperglycemia-Induced Histopathology
Relationship of Histopathology to Type of Diabetic Neuropathy
R.E. Schmidt
Neuropathology of Clinical Diabetic Autonomic Neuropathy
Experimental Diabetic Autonomic Neuropathy
Pathobiochemistry and Pathophysiology
D. Ziegler
Rapidly Reversible Nerve Dysfunction After Correction of Metabolic Derangement
Role of Intensive Diabetes Therapy in Treatment and Prevention of Diabetic Neuropathy
Is There a Glycemic Threshold for the Risk of Diabetic Complications?
Metabolic Alterations in Experimental Models
A.A.F. Sima and C.R. Pierson
Introduction
The Polyol Pathway and the Na+, K+-ATPase Defect
Role of Nonenzymatic Glycation
Role of Oxidative Stress and Alterations in Blood Flow
Role of Essential Fatty Acids
Role of Neurotrophic Factors
Neuropathy Associated with Hyperinsulinemia and Hypoglycemia
Physiologic Role of Proinsulin C-Peptide
Relationships Between Metabolic Alterations and Structural Pathology in Type 1 and Type 2 Diabetic Neuropathy
Future Directions
Summary
Glycation and Advanced Glycation Reactions
J. W. Baynes
Introduction
Maillard Reaction Products
Diabetic Neuropathy
Conclusions
Polyolpathway: Aldose Reductase Inhibitors—Hope for the Future?
E.L. Feldman. K.A. Sullivan, and M.J. Stevens
Introduction
Pathophysiology
Therapy
Summary
Nerve Blood Flow
M.A. Cotter. A. Veves. S. Tesfaye, and N.E. Cameron
Introduction
Nerve Blood Flow in Diabetic Patients
Nerve Axon Reflex
Blood Vessel Morphology in Diabetic Nerves
Treatments to Test the Vascular Hypothesis in Peripheral Diabetic Neuropathy
Importance of Neuron Cell Bodies
Oxidative Stress: An Integrative View
P.A. Low
Introduction
Presence of Oxidative Stress in Human and Experimental Diabetes
Free Radical Defenses Are Reduced in Peripheral Nerve
Reduced Oxygen Species Are Increased In Experimental Diabetic Neuropathy
Changes in Pro-oxidant Status
Neural Targets of Oxidant Stress
Synthesis of Pathogenetic Hypothesis
Concluding Thoughts
Neurotrophic Factors
A. Vinik, C. Pittenger, K. Stansberry, T.S. Park, T. Erbas. and M. Skeen
Introduction
Insulin and IGFs as Neurotrophic Factors
Neuroimmunophilins
Programmed Cell Death and Neuropathy
Glutamate Neurotoxicity and Its Prevention
NAAGS in Diabetic Neuropathy
Therapeutic Potential for Growth Factors
Caveats on the Use of Neurotrophic Factors in the Clinic
Autoimmunity
P.J. Watkins and G. Sundkvist
Introduction
Autoimmunity and the Nervous System
Conclusions
References
5 Clinical Features and Treatment of Diabetic Neuropathy
Severity and Staging of Diabetic Polyneuropathy
P.J. Dyck
Why Quantitate the Severity of Diabetic Polyneuropathy?
How Is Severity of Diabetic Polyneuropathy to Be Judged?
Minimum Criteria for the Diagnosis of Diabetic Neuropathy
Can Neuropathic Abnormalities Be Demonstrated in Patients Who Do not Fulfill Minimum Criteria for Diabetic Polyneuropathy?
Severity of Neuropathic Symptoms
Continuous Measures of Neuropathic Impairment
Composite Scores for Diabetic Polyneuropathy Severity
Staging Severity of Diabetic Polyneuropathy
Classification of the Diabetic Neuropathies
P.K. Thomas
Hyperglycemic Neuropathy
Diabetic Distal Sensory or Sensorimotor Polyneuropathy
Acute Painful Diabetic Neuropathy
Autonomic Neuropathy
Acute Motor Neuropathy
Focal and Multifocal Neuropathies
Cranial Neuropathies
Thoracolumbar Radiculoneuropathy
Proximal Diabetic Neuropathy
Focal Limb Nerve Lesions
Superimposed Chronic Inflammatory Demyelinating Polyneuropathy
Hypoglycemic Neuropathy
Diabetic Sensorimotor Neuropathy: Methods of Assessment
Electrophysiologic Testing
V. Bril
Introduction to Electrophysiology
Nerve Conduction Studies in Neuropathies: An Overview
Axonal Neuropathies: Diabetic Neuropathy as the Prototype
Methodology
Limitations
Summary
Quantitative Sensory Testing
J.C. Arezzo
Introduction
Pathophysiology Underlying the Elevation of Sensory Thresholds
Methodology
Vibration Perception Threshold
Thermal Perception Threshold
Simple Devices
Epidemiologic Studies and Multicenter Clinical Trials
Limitations of QST in the Assessment of Diabetic Neuropathy
Motor Function
H. Andersen and J. Jakobsen
Introduction
Muscle Strength
Visualization and Quantification of Striated Muscle
Conclusions
Unmyelinated Nerves: Skin Biopsy and Skin Blister Methods
W.R. Kennedy and G. Wendelschafer-Crabb
Introduction
Biopsy/Blister Procedures, Staining, and Imaging
Quantitation of Nerves in a Skin Biopsy and Blister
Cutaneous Nerves in Diabetic Neuropathy
Advantages of Skin Biopsy/Blister Methods
When and Where to Biopsy/Blister
ENF Density and Sensation
Conclusion
Diabetic Sensorimotor Neuropathy: Clinical Features
Symmetric Distal Polyneuropathy
B. Neundürfer and P.K. Thomas
Definition
Clinical Picture
Differential Diagnosis
Focal and Multifocal Neuropathies
P.K. Thomas
Cranial Neuropathies
Diabetic Truncal Radiculoneuropathy
Lumbosacral Radiculoplexus Neuropathy
Focal or Multifocal Limb Neuropathies
Treatment
Central Diabetic Neuropathy
G.J. Biessels and W.H. Gispen
Cognitive Functioning
Type 1 Diabetes
Type 2 Diabetes
Diabetes, Hyperinsulinemia, and Impaired Glucose Tolerance in the Elderly
Neurophysiology Findings
Evoked Potentials
Event-Related Potentials
Structural Cerebral Changes
Pathobiochemistry
Links with Peripheral Neuropathy
Interaction with Brain Aging
Cerebrovascular Alterations
Clinical Management
Diabetic Sensorimotor Neuropathy: Treatment
Mechanisms of Neuropathic Pain
P.K. Thomas
Pain in Distal Focal or Multifocal Diabetic Neuropathy
Pain in Diabetic Polyneuropathy
Mechanisms of Pain in Diabetic Neuropathy
Nerve Trunk Pain
Dysesthetic Pain
Peripheral Blood Flow
Glycemic Control
CNS Change Secondary to Damage to the Peripheral Nervous System
Treatment of Neuropathic Pain
D. Ziegler
Introduction
Neuropathic Pain
Clinical Features of Painful Diabetic Neuropathies
Diffuse Polyneuropathies
Measures of Neuropathic Pain
Treatment of Painful Diabetic Neuropathy
Symptomatic Nonpharmacologic Treatment
Conclusions
Diabetic Autonomic Neuropathy
Cardiovascular System
V. Spallone, G. Menzinger, and D. Ziegler
Introduction
Epidemiology, Risk Factors, and Prognosis
Clinical Features
Assessment
Clinical Impact
Respiratory Tract
L. Scionti and P. Bottini
Introduction
Abnormalities of Respiration
Gastrointestinal Tract
D. O'Donovan, M. Samson, C. Feinle, K.L. Jones, and M. Horowitz
Introduction
Pathophysiology of Disordered Gut Motility
Impact of Gastrointestinal Motility on Glycemic Control
Gastrointestinal Symptoms
Conclusion
Urogenital System
C.G. Stief and D. Ziegler
Introduction
Erectile Dysfunction
Oral Agents
Local Pharmacotherapy
Vacuum Devices
Penile Reconstructive Surgery
Prosthetic Surgery
Bladder Dysfunction
Sudomotor Function
P.A. Low
Normal Sweat Response
Tests of Sudomotor Function
Pupillary Function
R.H. Straub
Introduction
Anatomy and Physiology
Pupillary Autonomic Dysfunction in Diabetic Neuropathy
Endocrine Regulation in Response to Physiologic Maneuvers
J. Hilsted and M. Taskiran
Physical Exercise
Orthostatic Hypotension
Treatment
Response to Hypoglycemia
G.B. Bolli, C.G. Fanelli, F. Porcellati, and S. Pampanelli
Introduction
Physiology of Responses to Hypoglycemia
Definition of Hypoglycemia
Pathophysiology of Hypoglycemia in Type 1 Diabetes
Role of Recurrent Preceding Hypoglycemia in Responses to Hypoglycemia in Diabetic Autonomic Neuropathy
Contribution of Diabetic Autonomic Neuropathy Per Se to Reduced Plasma Epinephrine Responses to Hypoglycemia in Type 1 Diabetes
Conclusions
The Diabetic Foot
A.J.M. Boulton
Introduction
Epidemiology and Economic Aspects
Etiopathogenesis of Diabetic Foot Lesions
Sensorimotor Neuropathy
Autonomic Neuropathy
Other Risk Factors
Pathway to Ulceration
Complex Causality
The Patient with Sensory Loss
Prevention of Diabetic Foot Ulcers
Screening
Semmes-Weinstein Monofilaments
Vibration Perception Threshold and Thermal Threshold
Interventions for High Risk Patients
Education
Podiatry/Chiropody
Footwear/Orthoses/Hosiery
Silicone
Diabetic Charcot Neuroarthropathy
Foot Ulcers: Diagnosis and Management
Foot Ulcer Classification
Wound Healing in Diabetes
Off-Loading
Dressings
Management of Infection
Other Therapies
Prediction of Outcome
The Team Approach
Special Syndromes
Insulin, Hypoglycemia, and Peripheral Neuropathy
S.E.M. Eaton and S. Tesfaye
Introduction
Hypoglycemic Neuropathy
Insulin Neuritis (Acute Painful Neuropathy of Rapid Glycemic Control)
Implications for Diabetic Neuropathy
Ketosis-Related Neuropathy
R.A. Malik
Introduction
Diabetic Ketoacidosis-Associated Neuropathy
Models of Ketoacidotic Neuropathy
Diabetic Acute Motor Neuropathy
P.A. Low
Introduction
Acute or Subacute Distal Motor Neuropathy
Diabetic Proximal Motor Neuropathy
Diabetic Motor Mononeuropathies
Evaluation of Drug Effects
D. Luft and D. Ziegler
Introduction
Classification, Diagnosis, and Staging
Relevant Outcome Measures in Controlled Clinical Trials
Problems Related to the Use of Surrogate Variables
Clinical Measures
Electrodiagnostic Measures
Quantitative Sensory Testing
Morphologic Analysis
Autonomic Function Tests
Symptomatic Pain Treatment
Natural History
Sample Size and Duration of Trials
Reproducibility
Factors Confounding Treatment Effects
Measures of Relevant Treatment Effects
Definitions of Clinically Relevant Treatment Effects
Presentation of Treatment Effects
Statistical Evaluation of RCTs
Reporting of RCTs
Problems of Meta-analysis of Trials for the Treatment of Diabetic Neuropathy
External Validity of RCT Results
Conclusions
References
W. Rathmann and J. Ward
Direct Costs of Diabetic Neuropathy
Costs of Medical Care For Diabetic Neuropathy
Costs of Medication
Potential Cost Savings by Prevention of Diabetic Neuropathy
Methodologic Considerations
Costs of Foot Ulcer and Lower-Extremity Amputation
Cost-of-Illness Studies: Data Sources
Center-Based Studies
Databases (Health Insurance Companies)
Hospital-Based Studies
Further Studies on Costs of Diabetic Foot Complications
Economic Modeling: Benefits of Prevention
Cost-Effective Treatment of Diabetic Foot Ulcers
Conclusions
Indirect Consequences: Disability and Premature Death
Socioeconomic Status, Diabetic Neuropathy, and Foot Ulcer
Health-Related Quality of Life and Diabetic Neuropathy
Quality of Life and Peripheral Neuropathy
Quality of Life, Foot Ulcer, and Amputation
Psychological Aspects of Preventive Care
Burden to the Patient
References
7 Recommendations for Structured Care
F.A. Gries, P.A. Low, and D. Ziegler
Introduction
Outpatient Diabetes Care
Screening and Early Detection of Diabetic Neuropathy
Outpatient Care of Diabetic Neuropathy
References
Guidelines for the Diagnosis and Outpatient Management of Diabetic Peripheral Neuropathy
AJM Boulton, F.A. Gries and J.A. jervell
Definition
Assessment as Part of the Annual Review of the Patient
Management
Appendix 1: International Guide on the Outpatient Management of Diabetic Peripheral Neuropathy
Introduction
Peripheral Neuropathy in Diabetes
Definitions
Stages of Neuropathy
Assessment
Patient History
Examination of the Patient
Other Investigations
The “At Risk” Foot
Management
No Clinical Neuropathy (Stage 0/1)
Clinical Neuropathy (Stage 2)
Late Complications of Clinical Neuropathy (Stage 3)
Patient Education
Who Should Provide Patient Education?
What methods should be used?
What elements should the education programme contain?
Summary of the Management of Neuropathy
Acknowledgement
Appendix 2 List of Participants
Pilot Working Party, Brussels, Belgium 13 April 1995
Full Working Party, London, UK, 20-22 October 1995
