Complicações Neurológicas da Diabetes Mellitus
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https://doi.org/10.46531/sinapse/AR/132/2026Palavras-chave:
Complicações da Diabetes, Diabetes Mellitus, Doenças do Sistema Nervoso, Neuropatias DiabéticasResumo
A diabetes mellitus (DM) é uma doença com elevada prevalência global, que pode conduzir frequentemente a complicações neurológicas. O envolvimento do sistema nervoso periférico (SNP) pela diabetes inclui a polineuropatia (PNP) sensitivo-motora, neuropatia de pequenas fibras, neuropatia autonómica, a radiculoplexopatia lombossagrada, neuropatias cranianas e mononeuropatias compressivas. Relativamente às complicações do sistema nervoso central (SNC), estas podem dividir-se em crónicas, nomeadamente doença cerebrovascular e deterioração cognitiva, e agudas, tais como cetoacidose diabética, síndrome hiperosmolar hiperglicémico, mimetizadoras de evento vascular agudo, hemicoreia-hemibalismo, alterações de estado de consciência e crises epiléticas. Com a presente revisão narrativa, pretende-se sistematizar as várias complicações neurológicas da DM, com particular interesse na apresentação clínica e diagnóstico.
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Referências
International Diabetes Federation. IDF Diabetes Atlas, 10th edn. Brussels: IDF; 2021. Available at: https://www.diabete- satlas.org
Diabetes: Factos e Números – O Ano de 2019, 2020 e 2021. Relatório Anual do Observatório Nacional da Diabe- tes 03/2023. Lisboa: Sociedade Portuguesa de Diabetolo- gia;2022.
American Diabetes Association Professional Practice Com- mittee. 2. Diagnosis and classification of diabetes: Stand- ard s of Care in Diabetes—2024. Diabetes Care 2024;47: S20–S42
Viqimaa M, Sachinidis A, Toumpouleka M, Koutsampaso- poulos K, Alliksoo S, Titma T. Macrovascular Complications of Type 2 Diabetes Mellitus. Curr Vasc Pharmacol. 2020;18:110- 6. doi: 10.2174/1570161117666190405165151.
Fowler MJ. Microvascular and Macrovascular Complications of Diabetes. Clin Diabetes.2008; 26:77–82. doi:10.2337/ diaclin.26.2.77
Izenberg A, Perkins BA, Bril V. Diabetic Neuropathies. Semin Neurol. 2015;35:424-30. doi: 10.1055/s-0035-1558972. American Diabetes Association Professional Practice Committee. 12. Retinopathy, Neuropathy, and Foot Care: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S231-43. doi: 10.2337/dc24-S012.
Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of pe- ripheral neuropathy in patients with diabetes: a systematic review and meta-analysis. Prim Care Diabetes 2020;14:435- 44. doi:10. 1016/j.pcd.2019.12.005
Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. 3rd, Service FJ. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Roches- ter Diabetic Neuropathy Study. Neurology. 1993;43:817- 24. doi: 10.1212/wnl.43.4.817. Erratum in: Neurology. 1993;43:2345.
Vianello A, Racca F, Vita GL, Pierucci P, Vita G. Motor neu- ron, peripheral nerve, and neuromuscular junction disor- ders. Handb Clin Neurol. 2022;189:259-70. doi: 10.1016/ B978-0-323-91532-8.00014-8.
Callaghan BC, Gao L, Li Y, Zhou X, Reynolds E, Banerjee M, et al. Diabetes and obesity are the main metabolic drivers of peripheral neuropathy. Ann Clin Transl Neurol. 2018;5:397-405. doi: 10.1002/acn3.531.
Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement
Callaghan BC, Price RS, Feldman EL. Distal symmetric polyneuropathy: a review. JAMA. 2015; 314:2172-81. doi:10.1001/jama.2015.13611
Callaghan BC, Little AA, Feldman EL, Hughes RAC. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012;6:CD007543. doi:10.1002/14651858.CD007543.pub2
Look AHEAD Research Group. Effects of a long-term lifestyle modification programme on peripheral neuropathy in overweight or obese adults with type 2 diabetes: the Look AHEAD study. Diabetologia 2017;60:980-8. doi:10.1007/s00125-017-4253-z
Price R, Smith D, Franklin G, Gronseth G, Pignone M, David WS, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98:31-43. doi:10.1212/WNL.0000000000013038.
Engel AG. 2014 Diabetic Neuropathies. In: Katirji B, Kaminski HJ, Ruff RL, editors. Neuromuscular disorders in clinical practice. New York: Springer; 2014. p. 1073-9
Ko SH, Park SA, Cho JH, Song KH, Yoon KH, Cha BY, et al. Progression of cardiovascular autonomic dysfunction in patients with type 2 diabetes: a 7-year follow-up study. Diabetes Care. 2008;31:1832-6. doi:10.2337/dc08-0682.
Duque A,Mediano MFF, De Lorenzo A, Rodrigues LF. Cardiovascular autonomic neuropathy in diabetes: pathophysiology, clinical assessment and implications. World J Diabetes. 2021;12: 855-67. doi:10.4239/wjd.v12.i6.855
Tang Y, Shah H, Bueno Junior CR, Sun X, Mitri J, Sambataro M, et al. Intensive Risk Factor Management and Cardiovascular Autonomic Neuropathy in Type 2 Diabetes: The ACCORD Trial. Diabetes Care. 2021;44:164-73. doi:10.2337/dc20-1842.
Maser RE, Mitchell BD, Vinik AI, Freeman R. The association between cardiovascular autonomic neuropathy and mortality in individuals with diabetes: a meta-analysis. Diabetes Care. 2003;26:1895-901.
Research Group. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014;37:31-8. doi:10.2337/dc13-2114.
Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383-93. doi:10.1056/NEJMoa021778.
Ng PS, Dyck PJ, Laughlin RS, Thapa P, Pinto MV, Dyck PJ. Lumbosacral radiculoplexus neuropathy: Incidence and the association with diabetes mellitus. Neurology. 2019;92:e1188-94. doi:10.1212/WNL.000000000007020.
Dyck PJ, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. 1999;53:2113-21. doi:10.1212/WNL.53.9.2113
Barohn RJ, Sahenk Z, Warmolts JR, Mendell JR. The Bruns-Garland syndrome (diabetic amyotrophy). Revisited 100 years later. Arch Neurol. 1991;48:1130-5. doi:10.1001/archneur.1991.00530230038018.
Asbury AK, Daroff RB, Mackey EA. Oculomotor palsy in diabetes mellitus: a clinic-pathological study. Brain. 1970;93:555-66.
Lajmi H, Hmaied W, Ben Jalel W, Chelly Z, Ben Yakhlef A, Ben Zineb F, et al. Oculomotor palsy in diabetics. J Fr Ophthalmol. 2018;41:45-49. doi:10.1016/j.jfo.2017.06.010.
Dhume KU, Paul KE. Incidence of pupillary involvement, course of anisocoria and ophthalmoplegia in diabetic oculomotor nerve palsy. Indian J Ophthalmol. 2013;61:13-7.
Park UC, Kim SJ, Hwang JM, Yu YS. Clinical features and natural history of acquired third, fourth and sixth nerve palsy. Am J Ophthalmol. 2002;134:81-4.
Kung NH, Van Stavem GP. Isolated Ocular Motor Nerve Palises. Semin Neurol. 2015;35:539-48. doi:10.1055/s-0035-1563568.
Bell DS. Stroke in the diabetic patient. Diabetes Care. 1994;17:213-9.
Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al; ESC Scientific Document Group. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J. 2020;41:255-323. doi: 10.1093/eurheartj/ehz486. Erratum in: Eur Heart J. 2020;41:4317. doi: 10.1093/eurheartj/ehz828.
Lindegård B, Hillbom M. Associations between brain infarction, diabetes, and alcoholism: observations from the Gothenberg population cohort study. Acta Neurol Scand. 1987;75:195-200.
Palumbo PJ, Elveback LR, Whisnant JP. Neurological complications of diabetes mellitus: transient ischaemic attack, stroke, and peripheral neuropathy. Adv Neurol. 1978;19: 593-601.
Georgakis MK, Harshfield EL, Malik R, Franceschini N, Langenberg C, Wareham NJ, et al. Diabetes mellitus, glycemic traits, and cerebrovascular disease: a mendelian randomization study. Neurology. 2021;96:e1732-42. doi: 10.1212/WNL.000000000011555.
Solomon SD, Chew E, Duh EJ, Sobrin L, Sun JK, VanderBeek BL, et al. Diabetic Retinopathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40:412-8. doi: 10.2337/dc16-2641. Erratum in: Diabetes Care. 2017;40:809. doi: 10.2337/dc17-er06e. Erratum in: Diabetes Care. 2017;40:1285. doi: 10.2337/dc17-er09.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/ American Stroke Association. Stroke. 2019;50:e344-e418. doi: 10.1161/STR.0000000000000211. Erratum in: Stroke. 2019;50:e440-e441. doi: 10.1161/STR.0000000000000215.
Xue M, Xu W, Ou YN, Cao XP, Tan MS, Tan L, et al. Diabetes mellitus and risks of cognitive impairment and dementia: A systematic review and meta-analysis of 144 prospective studies. Ageing Res Rev. 2019;55:100944. doi: 10.1016/j.arr.2019.100944.
Monette MC, Baird A, Jackson DL. A meta-analysis of cognitive functioning in nondemented adults with type 2 diabetes mellitus. Can J Diabetes. 2014;38:401-8. doi: 10.1016/j.jcjd.2014.01.014.
Savelieff MG, Chen KS, Elzinga SE, Feldman EL. Diabetes and dementia: Clinical perspective, innovation, knowledge gaps. J Diabetes Complications. 2022;36:108333. doi: 10.1016/j.jdiacomp.2022.108333.
Brands AM, Biessels GJ, de Haan EH, Kappelle LJ, Kessels RP. The effects of type 1 diabetes on cognitive performance: a meta-analysis. Diabetes Care. 2005;28:726-35.
Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Study Research Group; Jacobson AM, Musen G, Ryan CM, Silvers N, Cleary P, et al. Long-term effect of diabetes and its treatment on cognitive function. N Engl J Med. 2007;356:1842-52. doi: 10.1056/NEJMoa066397. Erratum in: N Engl J Med. 2009;361:1914.
Karter AJ, Laiteerapong N, Chin MH, Moffet HH, Parker MM, Sudore R, et al. Ethnic Differences in Geriatric Conditions and Diabetes Complications Among Older, Insured Adults with Diabetes: The Diabetes and Aging Study. J Aging Health. 2015;27:894-918. doi: 10.1177/0898264315569455.
Mayeda ER, Whitmer RA, Yaffe K. Diabetes and cognition. Clin Geriatr Med. 2015;31:101-15.
Biessels GJ, Strachan MW, Visseren FL, Kappelle LJ, Whitmer RA. Dementia and cognitive decline in type 2 diabetes and prediabetic stages: towards targeted interventions. Lancet Diabetes Endocrinol. 2014;2:246-55. doi: 10.1016/S2213-8587(13)70088-3.
Smolina K, Wotton CJ, Goldacre MJ. Risk of dementia in patients hospitalized with type 1 and type 2 diabetes in England, 1998-2011: A retrospective national record linkage cohort study. Diabetologia. 2015;58:942-50.
Meneilly GS, Tessier DM. Diabetes, Dementia and Hypoglycemia. Can J Diabetes. 2016;40:73-6. doi: 10.1016/j.jcd.2015.09.006.
Livingston G, Huntley J, Liu KY, Costafreda SG, Selbaek G, Alladi S, et al. Dementia prevention, intervention, and care: 2024 report of the Lancet standing Commission. Lancet. 2024;404:572-628. doi: 10.1016/S0140-6736(24)01296-0.
Karslioglu FE, Donihi AC, Korytkowski MT. Diabetic ketoacidosis and hyperosmolar hyperglycemic syndrome: review of acute decompensated diabetes in adult patients BMJ. 2019;365:1114 doi:10.1136/bmj.11114.
Mustafa OG, Haq M, Dashora U, Castro E, Dhatariya KK; Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Management of Hyperosmolar Hyperglycaemic State (HHS) in Adults: An updated guideline from the Joint British Diabetes Societies (JBDS) for Inpatient Care Group. Diabet Med. 2023;40:e15005. doi: 10.1111/dme.15005.
Pasquel FJ, Umpierrez GE. Hyperosmolar hyperglycemic state: a historic review of the clinical presentation, diagnosis, and treatment. Diabetes Care. 2014;37:3124-31.
Kitabchi AE, Umpierrez GE, Miles JM, Fisher JN. Hyperglycemic crises in adult patients with diabetes. Diabetes Care. 2009;32:1335-43.
Umpierrez GE, Murphy MB, Kitabchi AE. Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes Spectr. 2002;15:28-36.
Umpierrez GE, Davis GM, ElSayed NA, Fadini GP, Galindo RJ, Hirsch IB, et al. Hyperglycaemic crises in adults with diabetes: a consensus report. Diabetologia. 2024;67:1455-79. doi: 10.1007/s00125-024-06183-8.
American Diabetes Association Professional Practice Committee. 6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes-2024. Diabetes Care. 2024;47:S111-S125. doi: 10.2337/dc24-S006.
Tesfaye N, Seaquist ER. Neuroendocrine responses to hypoglycemia. Ann N Y Acad Sci. 2010;1212:12-28. doi: 10.1111/j.1749-6632.2010.05820.x.
Beghi E, Carpio A, Forsgren L, Hesdorffer DC, Malmgren K, Sander JW, et al. (2010). Recommendation for a definition of acute symptomatic seizure. Epilepsia. 2010;51:671-5. doi:10.1111/j.1528-1167.2009.02285.x.
Licchetta L, Ferri L, Morsillo F, Faustini-Fustini M, Toni F, Pondrelli F, et al. Clinical characterization of non-ketotic hyperglycemia-related seizures: A systematic review and individual participant data meta-analysis. Seizure. 2023;106;50-7. doi:10.1016/j.seizure.2023.01.018.
Herzig-Nichtweil J, Salih F, Berning S, Malter MP, Pelz JO, Lochner P, et al. Prognosis and management of acute symptomatic seizures: a prospective, multicenter, observational study. Ann Intensive Care. 2023;13:85. doi: 10.1186/s13613-023-01183-0.
Kitabchi AE, Umpierrez GE, Murphy MB, Barrett EJ, Kreisberg RA, Malone JL, et al. Management of hyperglycemic crises in patients with diabetes. Diabetes Care. 2001;24: 131-53
Cryer PE. Glycemic goals in diabetes: trade-off between glycemic control and iatrogenic hypoglycemia. Diabetes. 2014;63:2188-95.
Bala MI, Chertcoff A, Saucedo M, Gonzalez F, Miquelini LA, Bonardo P, et al. Teaching Neurolmages: Nonketotic hyperglycemic hyperosmolar state mimicking acute ischemic stroke. Neurology. 2020;95:e2600-1. doi: 10.1212/WNL.000000000010649.
Marren SM, Beale A, Yin GS. Hyperosmolar hyperglycaemic state as a stroke cause or stroke mimic: an illustrative case and review of literature. Clin Med. 2022;22:83-6. doi: 10.7861/clinmed.2021-0734.
Luitse MJ, Biessels GJ, Rutten GE, Kappelle LJ. Diabetes, hyperglycaemia, and acute ischaemic stroke. Lancet Neurol. 2012;11:261-71.
Sharma M, Menon B, Manam G. Hypoglycemic hemiparesis as stroke mimic with transient splenial lesion and internal capsule involvement: A reversible clinico-radiological concurrence. J Postgrad Med. 2022;68:109-11. doi: 10.4103/jpgm.jpgm_817_21.
Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2019;50(12):e344-e418. doi:10.1161/STR.00000000000000211.
Arecco A, Ottaviani S, Boschetti M, Renzetti P, Marinelli L. Diabetic striatopathy: an updated overview of current knowledge and future perspectives. J Endocrinol Invest. 2024;47:1-15. doi: 10.1007/s40618-023-02166-5.
Chua CB, Sun CK, Hsu CW, Tai YC, Liang CY, Tsai IT. "Diabetic striatopathy": clinical presentations, controversy, pathogenesis, treatments, and outcomes. Sci Rep. 2020;10:1594. doi: 10.1038/s41598-020-58555-w.
Aras YG, Ulas SN, Acar T, Acar BA. Hemiballism and cholera with acute/subacute onset: a retrospective series. Acta Neurol Belg. 2023;123:591-7. doi:10.1007/s13760-023-02206-0.
Oh SH, Lee KY, Im JH, Lee MS. Chorea associated with non-ketotic hyperglycemia and hyperintensity basal ganglia lesion on T1-weighted brain MRI study: a meta-analysis of 53 cases including four present cases. J Neurol Sci. 2002;200:57-62. doi: 10.1016/s0022-510x(02)00133-8. PMID: 12127677.
Cincotta M, Walker RH. One Side of the Story; Clues to Etiology in Patients with Asymmetric Chorea. Tremor Other Hyperkinet Mov. 2022;12:3. doi: 10.5334/tohm.675.
Direção Geral da Saúde. Norma para o Tratamento Farmacológico da Dor Neuropática no Adulto e Idoso n° 043/2011 de 23/12/2011 atualizada em 13/07/2017. [Acedido em 26-01-2025]. Disponível em: https://normas.dgs.min-saude.pt/wp-content/uploads/2019/09/tratamento-farmacologico-da-dor-neuropatica-no-adulto-e-idoso.pdf
Lai PH, Tien RD, Chang MH, Teng MM, Yang CF, Pan HB, at al. Chorea-ballismus with nonketotic hyperglycemia in primary diabetes mellitus. AJNR Am J Neuroradiol. 1996;17:1057-64.
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Direitos de Autor (c) 2024 Catarina Borges, André Costa, Pedro Guimarães, Vanessa Pires, Michel Mendes
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