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Hyperglycemia, increased sorbitol and protein kinase C, elevated homocysteine, reduced nitric oxide and excessive Reactive Oxygen Species (ROS) damage endothelial tissue and produce a rheological change that increases vascular resistance and reduces blood flow to the nerve 3.3 Risk factors Diabetes is the strongest risk factor for DPN, along with certain disease characteristics such as diabetes duration and poor glycemic control in terms of fasting blood glucose (FBG), glycated hemoglobin (HbA1c

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Lancet Neurol 16:750760 Tanner CM, Ross GW, Jewell SA, Hauser RA, Jankovic J, Factor SA, Bressman S, Deligtisch A, Marras C, Lyons KE, Bhudhikanok GS, Roucoux DF, Meng C, Abbott RD, Langston JW (2009) Occupation and risk of parkinsonism: a multicenter case-control study