Department of Endocrinology, Pennine Acute Hospitals NHS Trust, Greater Manchester, United Kingdom.
Institute of Cardiovascular Science, University of Manchester and the Manchester Royal Infirmary, Central Manchester Hospital Foundation Trust, Manchester, United Kingdom.
Clin Ther. 2018 Jun;40(6):828-849. doi: 10.1016/j.clinthera.2018.04.001. Epub 2018 Apr 30.
Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN.
A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors' expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN.
DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration.
Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.
糖尿病周围神经病变（DPN）是全球最常见的神经病变原因，其患病率随着糖尿病病程的延长而增加。它影响大约一半的糖尿病患者。DPN 呈对称性，主要为感觉神经病变，从远端开始，并逐渐向近端呈手套和袜子样分布扩散。它会导致大量的发病率，并与死亡率的增加有关。这种情况下疼痛的持续性质会对患者的睡眠、情绪和功能产生负面影响，并导致生活质量下降。本综述的目的是批判性地回顾 DPN 的诊断和治疗的现有文献，重点关注 DPN 中神经性疼痛的治疗。
进行了全面的文献综述，包括电子数据库（EMBASE、PubMed、OVID）中的文章搜索以及相关文章的参考文献列表，同时考虑了作者在 DPN 方面的专业知识。本综述考虑了在流行病学方面的开创性和新颖性研究；诊断，特别是与新的替代终点有关的诊断；以及 DPN 中神经性疼痛的治疗。我们还考虑了治疗痛性 DPN 的潜在新的药物治疗方法。
DPN 经常被误诊和治疗不足。除了改善血糖控制外，对于糖尿病神经病变，没有经过许可的病因治疗方法。由于在个体化治疗和确定最佳剂量策略、初始药物治疗选择、考虑联合治疗以及确定对镇痛反应不佳者的治疗等方面存在困难，痛性 DPN 的管理仍然具有挑战性。度洛西汀和普瑞巴林仍然是美国临床内分泌医师协会、美国神经病学学会、欧洲神经病学会联合会、英国国家临床卓越研究所和美国糖尿病协会发布的 5 个主要指南中治疗 DPN 神经性疼痛的一线药物治疗方法，并且已获得美国食品和药物管理局的批准。
临床识别 DPN 对于及时进行症状管理以减少与该疾病相关的发病率至关重要。
