Diabetic polyneuropathies: Update on research definition, diagnostic criteria and estimation of severity

Peter J. Dyck, James W. Albers, Henning Andersen, Joseph C. Arezzo, Geert Jan Biessels, Vera Bril, Eva L. Feldman, William J. Litchy, Peter C. O'Brien, James W. Russell

Research output: Contribution to journalReview articlepeer-review

225 Scopus citations


Prior to a joint meeting of the Neurodiab Association and International Symposium on Diabetic Neuropathy held in Toronto, Ofntario, Canada, 13-18 October 2009, Solomon Tesfaye, Sheffield, UK, convened a panel of neuromuscular experts to provide an update on polyneuropathies associated with diabetes (Toronto Consensus Panels on DPNs, 2009). Herein, we provide definitions of typical and atypical diabetic polyneuropathies (DPNs), diagnostic criteria, and approaches to diagnose sensorimotor polyneuropathy as well as to estimate severity. Diabetic sensorimotor polyneuropathy (DSPN), or typical DPN, usually develops on long-standing hyperglycaemia, consequent metabolic derangements and microvessel alterations. It is frequently associated with microvessel retinal and kidney disease-but other causes must be excluded. By contrast, atypical DPNs are intercurrent painful and autonomic small-fibre polyneuropathies. Recognizing that there is a need to detect and estimate severity of DSPN validly and reproducibly, we define subclinical DSPN using nerve conduction criteria and define possible, probable, and confirmed clinical levels of DSPN. For conduct of epidemiologic surveys and randomized controlled trials, it is necessary to pre-specify which attributes of nerve conduction are to be used, the criterion for diagnosis, reference values, correction for applicable variables, and the specific criterion for DSPN. Herein, we provide the performance characteristics of several criteria for the diagnosis of sensorimotor polyneuropathy in healthy subject- and diabetic subject cohorts. Also outlined here are staged and continuous approaches to estimate severity of DSPN.

Original languageEnglish (US)
Pages (from-to)620-628
Number of pages9
JournalDiabetes/Metabolism Research and Reviews
Issue number7
StatePublished - Oct 2011


  • Atypical diabetic polyneuropathy
  • Classification
  • Definitions
  • Diabetic polyneuropathy
  • Diabetic sensorimotor polyneuropathy

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology


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