Ang Lynn, Cowdin Nathan, Mizokami-Stout Kara, Pop-Busui Rodica
Division of Metabolism, Endocrinology and Diabetes, Department of Internal Medicine, University of Michigan, Ann Arbor, MI.
Department of Physiology, University of Michigan, Ann Arbor, MI.
Diabetes Spectr. 2018 Aug;31(3):224-233. doi: 10.2337/ds18-0036.
Distal symmetric polyneuropathy (DSPN) and diabetic autonomic neuropathies, particularly cardiovascular autonomic neuropathy (CAN), are prevalent diabetes complications with high morbidity, mortality, and amputation risks. The diagnosis of DSPN is principally a clinical one based on the presence of typical symptoms combined with symmetrical, distal-to-proximal stocking-glove sensory loss. CAN is an independent risk factor for cardiovascular mortality, arrhythmia, silent ischemia, major cardiovascular events, and myocardial dysfunction. Screening for CAN in high-risk patients is recommended. Symptoms of gastroparesis are nonspecific and do not correspond with its severity. Diagnosis of gastroparesis should exclude other factors well documented to affect gastric emptying such as hyperglycemia, hypoglycemia, and certain medications. There is a lack of treatment options targeting the neuropathic disease state. Managing neuropathic pain also remains a challenge. Given the high risk of addiction, abuse, psychosocial issues, and mortality, opioids are not recommended as first-, second-, or third-line agents for treating painful DSPN.
远端对称性多发性神经病变（DSPN）和糖尿病自主神经病变，尤其是心血管自主神经病变（CAN），是常见的糖尿病并发症，具有高发病率、高死亡率和截肢风险。DSPN的诊断主要基于典型症状的存在以及从远端到近端的对称性手套袜套样感觉丧失。CAN是心血管死亡、心律失常、无症状性缺血、重大心血管事件和心肌功能障碍的独立危险因素。建议对高危患者进行CAN筛查。胃轻瘫的症状不具特异性，且与病情严重程度不相符。胃轻瘫的诊断应排除其他已被充分证明会影响胃排空的因素，如高血糖、低血糖和某些药物。目前缺乏针对神经病变状态的治疗选择。管理神经性疼痛仍然是一项挑战。鉴于成瘾、滥用、社会心理问题和死亡率的高风险，不建议将阿片类药物作为治疗疼痛性DSPN的一线、二线或三线药物。
