Diabetes Standards of Care and Resources for Clinicians and Educators

There are two main types of diabetic neuropathy: distal symmetric polyneuropathy and autonomic neuropathy.

• Distal symmetric polyneuropathy, often referred to as peripheral neuropathy, most commonly affects the feet and legs in people with diabetes, and is the major cause of lower extremity problems, including pain, ulceration, and amputations. See the Foot Care Standard of Care for recommendations on DPN screening, management, and referral.
 
• Autonomic neuropathy is responsible for various cardiovascular, gastrointestinal, and genitourinary clinical problems that can have significant associated morbidity and increased mortality rates. This form of neuropathy can manifest as: resting tachycardia, exercise intolerance, orthostatic hypotension, constipation, gastroparesis, erectile dysfunction, and sudomotor dysfunction. Screening consists of assessing signs and symptoms of autonomic dysfunction when taking the patient's history and during physical examination. Treatments are available for symptomatic autonomic neuropathy that may improve quality of life, but these treatments do not alter the disease process. See the resources below for sources that contain comprehensive discussions of this topic.