Diabetic neuropathy, a common complication of diabetes mellitus, affects nearly 50% of all cases of type 1 and type 2 diabetes mellitus. It is characterized by the presence of signs and symptoms of peripheral nerve dysfunction along with gradual loss of nerve function in diabetic people after ruling out other possible causes of neuropathy.
Diabetic neuropathy may be present at diagnosis or only a few years of diabetes diagnosis in type 2 diabetes, whereas in type 1 diabetes, the signs and symptoms of diabetic neuropathy present after chronic hyperglycemia. Mostly the sensory nerves, motor nerves or autonomic or a combination are affected and in some advanced cases, all the nerve types are affected. More than 7.5% of cases have diabetic neuropathy at the time of diagnosis, which after 25 years increases to 45%.(1)
The cause of diabetic neuropathy is multifactorial, which includes advanced age, poor glycemic control, long duration of diabetes mellitus, hypertension, hyperlipidemia, smoking, tall height, heavy alcohol intake, and HLA-DR3/4 phenotype. The symptoms have a stocking and glove distribution of sensory sensations, which include a feeling of numbness, loss of balance, painless injuries due to loss of sensation, burning, prickling pain, tingling, electric shock-like feeling, aching, tightness or increased sensitivity to touch. Motor symptoms include toe and foot weakness, impaired hand coordination, difficulty climbing the stairs and frequent falls. Autonomic symptoms include orthostatic hypotension, persistent sinus tachycardia, sinus arrhythmia, syncope, dysphagia, abdominal pain, nausea and vomiting, diarrhea/constipation, fecal incontinence, malabsorption, lower urinary tract symptoms, sweating, heat intolerance, and erectile dysfunction.
Is There Is A Surgery For Diabetic Neuropathy?
The most important approach in controlling and slowing the progression of diabetic neuropathy is tight glucose control. There are also several medications for the pain management in patients with diabetic neuropathy, which include pregabalin, gabapentin, sodium valproate, dextromethorphan, morphine sulfate, tramadol, oxycodone, duloxetine, amitriptyline, venlafaxine, and transdermal lidocaine.(1)
Although most of the management of diabetic neuropathy is done by conservation methods, surgery may be required in managing some conditions that are beyond the conservative approach. Surgery is needed to treat infected foot ulcers when the infection is not controlled with medications. Surgery in the form of aggressive debridement of the wound or on occasions even amputation of the limb may be required if necrosis is noted or there is no improvement of the infection post IV antibiotic treatment.(1)
Patients with diabetes lose sensations in their feet and their feet become susceptible to not only ulcers but also to Charcot’s foot. Charcot’s foot is a foot that becomes structurally abnormal due to acute arthropathy or frequent and multiple trauma. It can occur in diabetic peripheral neuropathy as well as in other types of neuropathy and can be treated with bracing or orthotics. However, some cases may require surgery to correct foot abnormality.(1)
Patients with unmanageable gastroparesis, especially in those who have severe nausea and vomiting and weight loss may need to undergo jejunostomy. This helps in enteric nutrition that can bypass the paralytic stomach. In cases of erectile dysfunction and persistent impotence, patients opt for penile prosthesis.(1)
In the past decade, decompression nerve surgery has been evaluated for its effectiveness in diabetic patients, especially those with painful diabetic peripheral neuropathy. Studies have shown that decompression or release of the affected nerve in the affected extremity has shown a decrease in pain and improved sensation in most of the patients who underwent decompression nerve surgery. Patients who underwent the surgery did not develop a diabetic foot ulcer and the patients with previous ulcerations had reduced rate of ulcerations now. Overall, the pain and restoration of sensation are seen in about 80% of the patients with diabetic peripheral neuropathy who undergo decompression nerve surgery.(2)
However, decompression nerve surgery is not opted-in clinical setting as most of the studies are just observational studies and there is a need for further research and studies to prove the efficacy of the surgery to be adopted in a clinical setting.