Diabetic neuropathy.
Diabetic neuropathy.
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DOI：
10.1038/s41572-019-0097-9
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发表时间：
2019-06-13
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糖尿病前期和糖尿病的全球流行导致了这些疾病并发症的相应流行。最常见的并发症是神经病变，其中远端对称性多发性神经病变(在本初级读物中称为糖尿病神经病变)非常常见。糖尿病神经病变是一种始于下肢远端的感觉功能丧失，也以疼痛和严重的发病率为特征。随着时间的推移，至少50%的糖尿病患者会出现糖尿病神经病变。血糖控制有效地阻止了1型糖尿病患者糖尿病神经病变的进展，但对2型糖尿病患者的影响较小。这些发现为理解糖尿病神经病变的病因学做出了新的努力，并在2017年就预防和治疗这种疾病的方法提出了新的建议，具体针对每种类型的糖尿病。与此同时，已经发布了使用不同类别的药物治疗痛性糖尿病神经病变的新指南，重点是避免使用阿片类药物。尽管我们对糖尿病神经病变的复杂性的了解在过去十年中有了很大的发展，但1型和2型糖尿病神经病变的不同机制仍不清楚。未来对疾病发病机制的发现将是成功解决糖尿病神经病变从预防到治疗的所有方面的关键。
The global epidemic of prediabetes and diabetes has led to a corresponding epidemic of complications of these disorders. The most prevalent complication is neuropathy, of which distal symmetric polyneuropathy (for the purpose of this Primer, referred to as diabetic neuropathy) is very common. Diabetic neuropathy is a loss of sensory function beginning distally in the lower extremities that is also characterized by pain and substantial morbidity. Over time, at least 50% of individuals with diabetes develop diabetic neuropathy. Glucose control effectively halts the progression of diabetic neuropathy in patients with type 1 diabetes mellitus, but the effects are more modest in those with type 2 diabetes mellitus. These findings have led to new efforts to understand the aetiology of diabetic neuropathy, along with new 2017 recommendations on approaches to prevent and treat this disorder that are specific for each type of diabetes. In parallel, new guidelines for the treatment of painful diabetic neuropathy using distinct classes of drugs, with an emphasis on avoiding opioid use, have been issued. Although our understanding of the complexities of diabetic neuropathy has substantially evolved over the past decade, the distinct mechanisms underlying neuropathy in type 1 and type 2 diabetes remains unknown. Future discoveries on disease pathogenesis will be crucial to successfully address all aspects of diabetic neuropathy, from prevention to treatment.