Ziegler Dan
German Diabetes Clinic, German Diabetes Center, Leibniz Institute at the Heinrich Heine University, WHO Collaborating Center in Diabetes, European Training Center in Endocrinology and Metabolism, Düsseldorf, Germany.
Ann N Y Acad Sci. 2006 Nov;1084:250-66. doi: 10.1196/annals.1372.008.
At least one of four diabetic patients is affected by distal symmetric polyneuropathy (DSP), which represents a major health problem, as it may present with partly excruciating neuropathic pain and is responsible for substantial morbidity, increased mortality, and impaired quality of life. Treatment is based on four cornerstones: (a) causal treatment aimed at (near)-normoglycemia, (b) treatment based on pathogenetic mechanisms, (c) symptomatic treatment, and (d) avoidance of risk factors and complications. Recent experimental studies suggest a multifactorial pathogenesis of diabetic neuropathy. From the clinical point of view it is important to note that, on the basis of these pathogenetic mechanisms, therapeutic approaches could be derived, some of which are currently being evaluated in clinical trials. Among these agents only alpha-lipoic acid is available for treatment in several countries and epalrestat in Japan. Although several novel analgesic drugs, such as duloxetine and pregabalin, have recently been introduced into clinical practice, the pharmacological treatment of chronic painful diabetic neuropathy remains a challenge for the physician. Individual tolerability remains a major aspect in any treatment decision. Epidemiological data indicate that not only increased alcohol consumption but also the traditional cardiovascular risk factors, such as hypertension, smoking, and visceral obesity, play a role in development and progression of diabetic neuropathy and, hence, need to be prevented or treated.
每四名糖尿病患者中至少有一人会受到远端对称性多发性神经病变（DSP）的影响，这是一个重大的健康问题，因为它可能会出现部分极其痛苦的神经性疼痛，并且会导致大量发病、死亡率增加以及生活质量受损。治疗基于四个基石：（a）旨在实现（接近）正常血糖水平的病因治疗，（b）基于发病机制的治疗，（c）对症治疗，以及（d）避免危险因素和并发症。最近的实验研究表明糖尿病神经病变具有多因素发病机制。从临床角度来看，重要的是要注意到，基于这些发病机制，可以推导得出治疗方法，其中一些目前正在临床试验中进行评估。在这些药物中，只有α-硫辛酸在几个国家可用于治疗，在日本可使用依帕司他。尽管最近有几种新型镇痛药，如度洛西汀和普瑞巴林，已被引入临床实践，但慢性疼痛性糖尿病神经病变的药物治疗对医生来说仍然是一个挑战。个体耐受性仍然是任何治疗决策中的一个主要方面。流行病学数据表明，不仅饮酒量增加，而且传统的心血管危险因素，如高血压、吸烟和内脏肥胖，在糖尿病神经病变的发生和发展中都起作用，因此需要预防或治疗。
