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February 3, 2010

Diabetic Polyneuropathy and Glucose Control—Reply

JAMA. 2010;303(5):420-421. doi:10.1001/jama.2010.56

In Reply: Dr Finucane rightly questions the relationship between hyperglycemia and the development of diabetic polyneuropathy in patients with type 2 diabetes and whether tight control is truly effective. The 3 RCTs he cites did not show a reduction in the prevalence of the disorder in those whose serum glucose was tightly controlled.

One of the major obstacles in addressing this question is establishing a diagnosis of polyneuropathy (and diabetic polyneuropathy in particular). An expert consensus report1 on the definition of polyneuropathy underscored the difficulty of deciding what actually constitutes a polyneuropathy. But the authors of that report did stress the importance of including several criteria, including nerve conduction studies and possibly epidermal nerve fiber counts, as part of that definition.