geoffrey modest medical blogs

The American D iabetes Association just came out with their position paper on diabetic neuropathy (see   dm   neurop  guidelines ADA2017  in  dropbox , or  DOI: 10.2337/dc16-2042 ). I will limit my points to type 2 diabetes, though type 1 is covered in this paper Summary of points: -- diabetic neuropathy is a diagnosis of exclusion: diabetic patients may well have non-diabetic causes of neuropathy that should be pursued. -- 50% of diabetic neuropathies are asymptomatic. It is important to assess for them, for example, to decrease the likelihood of significant foot trauma, improve symptoms and quality of life, and decrease sequelae -- prevention of neuropathy:    -- data are largely for distal symmetric polyneuropathy (DSPN) and for cardiovascular autonomic neuropathy (CAN).    -- Best evidence is for those with type I diabetes where it is important to optimize glucose control as early as possible:...

A recent Danish study found that vitamin B12 deficiency was associated with diabetic cardiovascular autonomic neuropathy, CAN (see  dm b12  def  and  autonom   neurop  jdiabcomplic2017  in  dropbox , or Hansen CS. J Diabetes  Complic . 2017; 31(1); 202) ​Details: -- 469 type II diabetic patients were screened for CAN by several measures, as well as for peripheral neuropathy. -- Mean age 59, 60% male, diabetes duration 10 years, 5% excessive alcohol consumption, 12% smokers, BMI 32, blood pressure 132/82, 6% on vitamin B12 supplementation (though 16% in those in the highest B12 quartile), 80% on lipid-lowering drugs, 75% on metformin, 4% on PPIs alone and 10% on the combination with metformin, 40% on insulin --CAN was measured after a 5-minute supine resting period:     -- heart rate variability (HRV)     -- 3 tests assessing cardiovascular autonomic reflexes:   ...