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