Prior to a joint meeting of the Neurodiab Association and International Symposium on Diabetic Neuropathy held in Toronto, Ontario, Canada, October 13-18, 2009, Solomon Tesfaye, Sheffield, UK convened a panel of neuromuscular experts to provide an update on polyneuropathies associated with diabetes (Toronto Consensus Panels on DPNs, 2009). Herein we provide definitions of typical and atypical DPN, diagnostic criteria, and approaches to diagnose sensorimotor polyneuropathy and to estimate severity. Typical DPN is a sensorimotor polyneuropathy (DSPN) usually developing on long standing hyperglycemia, consequent metabolic derangements and microvessel alterations, and frequently associated with microvessel retinal and kidney disease - but other causes must be excluded. By contrast atypical DPNs are intercurrent painful and autonomic small fiber polyneuropathies. Recognizing that there is a need to detect and estimate severity of DSPN validly and reproducibly, we define subclinical DSPN using nerve conduction criteria and define possible, probable and confirmed clinical levels of DSPN. For conduct of epidemiologic surveys and randomized controlled trials, it is necessary to pre-specify which attributes of nerve conduction are to be used, the criterion for diagnosis, reference values, correction for applicable variables, and the specific criterion for DSPN. Herein we provide the performance characteristics of several criteria for the diagnosis of sensorimotor polyneuropathy in healthy subject and diabetic subject cohorts. Also outlined here are staged and continuous approaches to estimate severity of DSPN. Copyright © 2011 John Wiley & Sons, Ltd.

Copyright © 2011 John Wiley & Sons, Ltd.