Though vitamin deficiencies may co-exist with diabetic neuropathy, they are not essential to its production. The administration
of thiamin, or other vitamins, without therapeutic control of diabetic metabolism, does not suffice to bring relief in true
diabetic neuropathy. Unlike the latter, thiamin deficiency neuropathy yields promptly to specific vitamin therapy.
In spite of our ignorance of the etiology of diabetic neuropathy I agree with those authors who maintain that poor management
of the diabetes is the important factor. My co-workers and I have observed numerous cases of diabetic neuropathy without clinical
evidence of atherosclerosis, which indicates that diabetesper se plays the dominant role in the precipitation or aggravation of the neuropathy of diabetes. It is not the severity of the
diabetes, but lack of control, which underlies neuropathy. In the final analysis the intimate mechanism by which diabetes
causes neuropathy is not known. The cause probably lies in some, as yet, obscure metabolic change in nerve tissue incidental
to uncontrolled diabetes.
Despite this lack of clear understanding of its mechanism, the management of diabetic neuropathy is hopeful. It is one complication
of diabetes which can be prevented, or cured, provided meticulous diabetic regulation is instituted sufficiently early.