Diabetic neuropathy
Diabetic neuropathy
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DOI：
10.1038/s41572-019-0092-1
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发表时间：
2019-06-13
影响因子：
81.5
通讯作者：
Viswanathan, Vijay
中科院分区：
文献类型：
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作者：
Feldman, Eva L.;Callaghan, Brian C.;Viswanathan, Vijay
全球糖尿病前期和糖尿病的流行，相应地引发了这些病症并发症的流行。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（在本入门指南中简称为糖尿病性神经病变）极为普遍。糖尿病性神经病变是一种始于下肢远端的感觉功能丧失，其特点还包括疼痛和较高的发病率。随着时间推移，至少50%的糖尿病患者会出现糖尿病性神经病变。血糖控制能有效阻止1型糖尿病患者糖尿病性神经病变的进展，但对2型糖尿病患者的效果则相对有限。这些研究结果促使人们做出新的努力，去了解糖尿病性神经病变的病因，同时在2017年针对每种类型的糖尿病，出台了预防和治疗该病症的新建议。与此同时，还发布了使用不同种类药物治疗糖尿病性疼痛性神经病变的新指南，重点是避免使用阿片类药物。尽管在过去十年里，我们对糖尿病性神经病变复杂性的认识有了很大进展，但1型和2型糖尿病神经病变背后的具体机制仍不清楚。未来对疾病发病机制的新发现，对于成功应对糖尿病性神经病变从预防到治疗的各个方面都至关重要。
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.