Diabetes and central and peripheral neurometabolic implications: an update

The incidence of any dementia is higher in diabetic patients than in controls, and any dementia includes both Alzheimer’s disease and vascular dementia. Alterations in glucose levels, insulin levels and amyloid metabolism are among the many factors suggested to underlie the pathophysiology, but it is not clear which of these mechanisms are clinically relevant. Neuropathy is a common complication of diabetes, present in a wide variety of scenarios. One of the most important forms is autonomic neuropathy, in particular cardiovascular autonomic neuropathy, which is responsible for severe clinical complications. No therapy has yet been identified that can stop or reverse autonomic neuropathy once it has become clinically evident. The reason for this, according to the newest discoveries, could be linked to the fact that diabetic neuropathy also affects the central nervous system. All this is leading to a critical rethinking of this disorder and opening up new avenues for future research.