Glucose Control and Diabetic Neuropathy: Lessons from Recent Large Clinical Trials
Glucose Control and Diabetic Neuropathy: Lessons from Recent Large Clinical Trials
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DOI：
10.1007/s11892-014-0528-7
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发表时间：
2014-09-01
影响因子：
4.2
通讯作者：
Pop-Busui, Rodica
中科院分区：
文献类型：
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作者：
Ang, Lynn;Jaiswal, Mamta;Pop-Busui, Rodica
糖尿病周围神经和自主神经病变是糖尿病常见的并发症，临床表现多样，发病率高。使用各种药物靶向参与糖尿病神经病变发展和进展的途径的研究在动物模型中是有希望的。然而，在人类中，随机对照研究未能显示对神经病变客观测量的有效性。周围神经和自主神经系统的复杂解剖结构、涉及的多种致病机制以及神经病变测量的缺乏统一性可能导致了这些失败。到目前为止，严格的血糖控制是唯一令人信服地证明可以预防或延缓1型糖尿病患者神经病变发展和减缓某些2型糖尿病患者神经病变进展的策略。本文综述了血糖控制在远端对称性多发性神经病和心血管自主神经病中的作用。
Diabetic peripheral and autonomic neuropathies are common complications of diabetes with broad spectrums of clinical manifestations and high morbidity. Studies using various agents to target the pathways implicated in the development and progression of diabetic neuropathy were promising in animal models. In humans, however, randomized controlled studies have failed to show efficacy on objective measures of neuropathy. The complex anatomy of the peripheral and autonomic nervous systems, the multitude of pathogenic mechanisms involved, and the lack of uniformity of neuropathy measures have likely contributed to these failures. To date, tight glycemic control is the only strategy convincingly shown to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in some patients with type 2 diabetes. Lessons learned about the role of glycemic control on distal symmetrical polyneuropathy and cardiovascular autonomic neuropathy are discussed in this review.