Diabetes and the Nervous System

Diabetic neuropathy is the most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care. It includes a set of clinical syndromes that affect distinct regions of the nervous system, singly or combined. Current research shows that diabetes can affect brain structure and function, and lead to significant changes in cognition and behavior. Peripheral neuropathy may be silent and go undetected or it may present with clinical symptoms and signs including pain that can significantly affect the patients’ quality of life. It also contributes to additional risks in the aging adult. Loss of sensory perception and muscle strength, and ataxia or incoordination leads to an increased risk of falling in the elderly. However, risk factors for falling are not simply confined to those variables associated with peripheral sensory-motor function. Cognitive decline, particularly related to executive functioning, is a contributing factor to instability. Cardiac autonomic neuropathy is a common complication of diabetes. Early diagnosis is key, as it has been shown to be an independent risk factor for cardiovascular mortality, arrhythmias, major cardiovascular event, and myocardial dysfunction. This chapter will describe our current knowledge on central, peripheral and autonomic nervous system alterations in response to prediabetes and type 1 and type 2 diabetes.