Diabetic neuropathy (DN) is the most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care (1,2). It is the most common form of neuropathy in the developed countries of the world, accounts for more hospitalizations than all the other diabetic complications combined, and is responsible for 50-75% of non-traumatic amputations (2) (3). DN is a set of clinical syndromes that affect distinct regions of the nervous system, singly or combined. It may be silent and go undetected, while exercising its ravages or it may present with clinical symptoms and signs that although nonspecific and insidious with slow progression but also mimic those seen in many other diseases. It is, therefore, diagnosed by exclusion. Unfortunately both endocrinologists and non endocrinologists have not been trained to recognize the condition (4), and even when symptomatic less than one third of physicians recognize the cause or discuss this with their patients (4)

The true prevalence is not known and reports vary from 10% to 90% in diabetic patients, depending on the criteria and methods used to define neuropathy (2,3,5) (6). Twenty five percent of patients attending a diabetes clinic volunteered symptoms; 50 % were found to have neuropathy after a simple clinical test such as the ankle jerk or vibration perception test; almost 90% tested positive to sophisticated tests of autonomic function or peripheral sensation (7). Neurologic complications occur equally in type 1 and type 2 diabetes mellitus and additionally in various forms of acquired diabetes (6). The major morbidity associated with somatic neuropathy is foot ulceration, the precursor of gangrene and limb loss. Neuropathy increases the risk of amputation 1.7 fold; 12 fold, if there is deformity (itself a consequence of neuropathy), and 36 fold, if there is a history of previous ulceration (8). Each year 96,000 amputations are performed on diabetic patients in the United States, yet up to 75% of them are preventable (3). Globally there is an amputation every 30 seconds. Diabetic neuropathy also has a tremendous impact on patients’ quality of life predominantly by causing weakness, ataxia and incoordination predisposing to falls and fractures (9) Once autonomic neuropathy sets in, life can become quite dismal and the mortality rate approximates 25-50% within 5-10 years (10) (11).