Yang Heng, Sloan Gordon, Ye Yingchun, Wang Shuo, Duan Bihan, Tesfaye Solomon, Gao Ling
Endocrinology Department, Renmin Hospital of Wuhan University, Wuhan, China.
Diabetes Research Unit, Sheffield Teaching Hospitals, Royal Hallamshire Hospital, Sheffield, United Kingdom.
Front Endocrinol (Lausanne). 2020 Jan 17;10:929. doi: 10.3389/fendo.2019.00929. eCollection 2019.
Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. It leads to distressing and expensive clinical sequelae such as foot ulceration, leg amputation, and neuropathic pain (painful-DPN). Unfortunately, DPN is often diagnosed late when irreversible nerve injury has occurred and its first presentation may be with a diabetic foot ulcer. Several novel diagnostic techniques are available which may supplement clinical assessment and aid the early detection of DPN. Moreover, treatments for DPN and painful-DPN are limited. Only tight glucose control in type 1 diabetes has robust evidence in reducing the risk of developing DPN. However, neither glucose control nor pathogenetic treatments are effective in painful-DPN and symptomatic treatments are often inadequate. It has recently been hypothesized that using various patient characteristics it may be possible to stratify individuals and assign them targeted therapies to produce better pain relief. We review the diagnostic techniques which may aid the early detection of DPN in the clinical and research environment, and recent advances in precision medicine techniques for the treatment of painful-DPN.
糖尿病周围神经病变（DPN）是糖尿病常见的慢性并发症。它会导致令人痛苦且费用高昂的临床后果，如足部溃疡、腿部截肢和神经病理性疼痛（疼痛性DPN）。不幸的是，DPN往往在不可逆的神经损伤发生后才被诊断出来，其首发症状可能是糖尿病足溃疡。目前有几种新的诊断技术，可辅助临床评估并有助于早期发现DPN。此外，针对DPN和疼痛性DPN的治疗方法有限。只有1型糖尿病严格控制血糖在降低发生DPN风险方面有确凿证据。然而，血糖控制和病因治疗对疼痛性DPN均无效，且对症治疗往往不足。最近有假说认为，利用各种患者特征，有可能对个体进行分层并给予针对性治疗，以更好地缓解疼痛。我们回顾了在临床和研究环境中可能有助于早期发现DPN的诊断技术，以及治疗疼痛性DPN的精准医学技术的最新进展。
