The near-future direction of research and medical care of human diabetic neuropathies

To improve overall detection, characterization, and treatment of diabetic neuropathies, it is essential that physicians appreciate that not all neuropathies in diabetic patients are from diabetes mellitus. Investigators and physicians should increasingly classify diabetic neuropathy into clearly defined varieties of diabetic neuropathy and quantify severity by stages and by continuous composite measures. Using these approaches, it will be possible to study onset, course, outcomes, risk factors, and treatment more adequately. These approaches should also be used to characterize and quantitate these complications in medical practice. In the near future, it should be possible to identify individual risk factor profiles for problematic degrees of diabetic polyneuropathy. Specific prevention and treatment of diabetic neuropathies are becoming available. For diabetic polyneuropathy, the main approach will be prevention of total hyperglycemic exposure. Other treatments to minimize the bad effects of chronic hyperglycemia exposure may become available. The recognition that immune mechanism may be implicated in multifocal diabetic neuropathies (lumbosacral plexus neuropathy, truncal radiculopathy, and oculomotor neuropathy) should lead to more focused studies of immune mechanisms involved and of treatment. It seems possible that many, perhaps most, upper limb mononeuropathies are preventable by avoidance of repetitive injury.