Report and recommendations of the San Antonio conference on diabetic neuropathy.

American Diabetes Association American Academy of Neurology O n 8-10 February 1988, a conference on peripheral neuropathy in diabetes was held in San Antonio, Texas, to review the progress achieved in this field over the past few years. A strong impetus for convening this conference was the recent burst of clinical investigations and trials in diabetic neuropathy and a perception that recent research gains were not widely recognized. The purpose of the conference was to assess the state of knowledge of diabetic neuropathy and to recommend a set of research guidelines for future clinical investigations. In this report , investigation was defined as epidemiological surveys , studies of natural history, and clinical trials of proposed therapies for treatment or prevention of diabetic neuropathy. The conference was sponsored by the American Diabetes Association and the American Academy of Neu-rology. The conference format consisted of a panel of 10 experts in the fields of diabetes and peripheral neu-ropathy who heard 1.5 days of presentations by 23 participants chosen for their expertise in particular aspects of diabetic neuropathy. The participants' presentations were divided into six areas: clinical measures, morphological and biochemical assessment, electrodiagnosis, epidemiology, autonomic nervous system testing, and sensory testing. The panel prepared this report on the conference. The following operational definition of diabetic peripheral neuropathy was adopted by the conferees: Diabetic neuropathy is a descriptive term meaning a de-monstrable disorder, either clinically evident or subclin-ical, that occurs in the setting of diabetes mellitus without other causes for peripheral neuropathy. The neuropathic disorder includes manifestations in the somatic and/or autonomic parts of the peripheral nervous system. Although the term diabetic neuropathy subsumes several distinctive neuropathic syndromes, this report fo-cuses on one of them, diabetic polyneuropathy. In reviewing the diagnosis and assessment of diabetic neuropathy, the panel was impressed with the large amount of data indicating general concordance among the various methods for detection and measurement of dysfunction. Thus, one major conclusion is that there is an underlying connection among the various abnormalities demonstrated by assessing nerve function. For each category of measurement, compelling evidence supported the validity of various approaches to assessment. Therefore, to fully classify diabetic neuropathy, the panel recommends at least one measure from each of the following categories: clinical symptoms, clinical examination, electrodiagnostic studies (F.DX), quantitative sensory testing (QST), and autonomic function testing (AFT). Because various methodologies are employed , each laboratory should standardize these measures by using their …