Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments.
Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments.
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DOI：
10.1016/s1474-4422(22)00188-0
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发表时间：
2022-10
期刊：
影响因子：
48
通讯作者：
Feldman, Eva L.
中科院分区：
文献类型：
--
作者：
Elafros, Melissa A.;Andersen, Henning;Bennett, David L.;Savelieff, Masha G.;Viswanathan, Vijay;Callaghan, Brian C.;Feldman, Eva L.
糖尿病周围神经病变（DPN）发生在多达一半的1型（T1D）和2型糖尿病（T2D）患者中。DPN是周围神经功能从远端到近端的丧失，导致身体残疾和可能的疼痛，降低生活质量。早期诊断可改善临床结局，但终生预后仍然较差。高血压是DPN的危险因素，血糖控制可减缓T1D患者的DPN。然而，它在T2D患者中具有适度的益处或没有益处，这可能是由于合并症的高患病率，包括代谢综合征，这是一个额外的风险因素。DPN的病理生理学是复杂的，但集中在一个统一的主题，生物能量失败的周围神经继发于其独特的解剖结构。目前的管理重点是控制糖尿病，代谢综合征和疼痛，但仍然不理想。因此，研究正在进行中，以改善早期诊断，确定特定的分子途径以开发基于机制的疗法，并研究生活方式干预措施以改善临床结果和疾病预后。
Diabetic peripheral neuropathy (DPN) occurs in up to half of individuals with types 1 (T1D) and 2 diabetes (T2D). DPN is a distal-to-proximal loss of peripheral nerve function causing physical disability and possibly pain, lowering quality-of-life. Early diagnosis improves clinical outcomes, but lifetime prognosis remains poor. Hyperglycemia is a DPN risk factor and glycemic control slows DPN in T1D. However, it has modest or no benefit in individuals with T2D, likely due to the high prevalence of comorbidities, including the metabolic syndrome, an additional risk factor. DPN pathophysiology is complex but converges on a unifying theme of bioenergetic failure in peripheral nerves secondary to their unique anatomy. Current management focuses on controlling diabetes, the metabolic syndrome, and pain, but remains suboptimal. Thus, research is on-going to improve early diagnosis, identify specific molecular pathways to develop mechanism-based therapies, and investigate lifestyle interventions to improve clinical outcomes and disease prognosis.