The neurological complications of diabetes mellitus: a clinical classification - abstract

ABSTRACT

Diabetic neurological disorders affect a significant proportion of our diabetic population in the Caribbean and world-wide. With the increasing life expectancy of today's diabetic population so has the incidence of these neurological disorders increased. Even without this, however, with early diagnosis it has been found that neurological lesions can occur early in the disease and in some instances be the presenting manifestation of hyperglycaemia. Over the ensuring years an increasing numbers of neurological syndromes have been identified affecting both somatic and autonomic nervous systems. These classifications have used either anatomical location, symmetrical or asymmetrical involving, focal or generlaised, functional disturbances, and have even been based on possible aetiological factors, recognisable clinical syndromes, type of nerve fibre implicated, pathological, and clinical course of the disorder, etc. In clinics and institutions where investigative tools such as electromyography, nerve conduction studies and the more refined biochemical modulations are available, classification of the syndromes on an anatomical or aetiological basis can be defined, but in settings such as ours and in institutions not having access to sophisticated neuro-investigations, clinicians have to rely on their clinical knowledge to specify and identify these neurological syndromes. In order to better identify these neurological lesions, we at the University of the West Indies. (Drs. C. McIver, E. Morrison, D. Kelly and R. Richards) began an attempt to identify and describe the neurological lesions and their prevalence in the diabetic population attending the Diabetic Clinic at the University Hospital of the West Indies between 1967 and 1969. Based on these clinical assessment we were able to identify a number of clinical presentations of neurological disorders in our diabetic subjects. We found that diabetic neuropathy or neurological disorders were present in 69 percent of the diabetic population, with neuropathy being present in 59 percent of the male and 36 percent of the female population attending the clinic over the period of assessment. Again, it was found that 12 percent - 15 percent of patients presenting with a history of a few months to two years had clinical features of diabetic neuropathey which at times could be ameliorated by normalisation of their hyperglycaemia (AU)