Diabetic neuropathy: classification, measurement and treatment.
Diabetic neuropathy: classification, measurement and treatment.
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DOI：
10.1097/med.0b013e328014979e
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发表时间：
2007-04-01
期刊：
影响因子：
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通讯作者：
Boulton, Andrew J M
中科院分区：
文献类型：
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作者：
Boulton, Andrew J M
综述目的：糖尿病神经病包括多种影响躯体或自主神经的病症，是最常见的长期糖尿病并发症。本综述考虑了躯体神经病分类和无创评估的最新进展，并描述了治疗疼痛性神经病症状的新方法。最新发现：糖尿病神经病的分类需要修改，以包括最近描述的“糖尿病前期神经病”或“糖耐量受损神经病”。越来越多的证据支持使用微创皮肤活检来评估小纤维神经病，最近，无创角膜共聚焦显微镜可以直接观察体内周围神经。对于那些患有疼痛性神经病症状的患者，现在有多种循证疗法可供选择。总结：“特发性神经病”患者应筛查糖耐量受损的证据，并考虑进行生活方式管理。潜在疗法的未来试验将受益于更相关的替代终点。患有疼痛性神经病的患者只能接受其疗效已得到独立随机对照试验证实的治疗。
PURPOSE OF REVIEW: Diabetic neuropathies comprise a number of conditions affecting somatic or autonomic nerves and are the most common of the long-term diabetic complications. This review considers recent developments in the classification and noninvasive assessment of somatic neuropathy, and describes new approaches to the management of painful neuropathic symptoms.RECENT FINDINGS: Classification of the diabetic neuropathies needs modifying to include the recently described 'prediabetic neuropathy' or 'neuropathy of impaired glucose tolerance'. There is increasing evidence to support the use of minimally invasive skin biopsies for evaluating small fibre neuropathies, and more recently, the noninvasive corneal confocal microscopy, which enables direct visualization of peripheral nerve in vivo. For those with painful neuropathic symptoms, a number of evidence-based therapies are now available.SUMMARY: Patients with 'idiopathic neuropathy' should be screened for evidence of impaired glucose tolerance and considered for lifestyle management. Future trials of potential therapies will benefit from more relevant surrogate endpoints. Those with painful neuropathy should only be prescribed therapies whose efficacy has been confirmed by independent randomized controlled trials.