Department of Health Science and Technology, Aalborg University Hospital, Aalborg University, Aalborg, Denmark.
Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
Curr Drug Saf. 2021;16(1):2-16. doi: 10.2174/1574886315666200731173113.
Diabetic peripheral neuropathy (DPN) is traditionally divided into large and small fibre neuropathy (SFN). Damage to the large fibres can be detected using nerve conduction studies (NCS) and often results in a significant reduction in sensitivity and loss of protective sensation, while damage to the small fibres is hard to reliably detect and can be either asymptomatic, associated with insensitivity to noxious stimuli, or often manifests itself as intractable neuropathic pain.
To describe the recent advances in both detection, grading, and treatment of DPN as well as the accompanying neuropathic pain.
A review of relevant, peer-reviewed, English literature from MEDLINE, EMBASE and Cochrane Library between January 1st 1967 and January 1st 2020 was used.
We identified more than three hundred studies on methods for detecting and grading DPN, and more than eighty randomised-controlled trials for treating painful diabetic neuropathy.
NCS remains the method of choice for detecting LFN in people with diabetes, while a gold standard for the detection of SFN is yet to be internationally accepted. In the recent years, several methods with huge potential for detecting and grading this condition have become available including skin biopsies and corneal confocal microscopy, which in the future could represent reliable endpoints for clinical studies. While several newer methods for detecting SFN have been developed, no new drugs have been accepted for treating neuropathic pain in people with diabetes. Tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors and anticonvulsants remain first line treatment, while newer agents targeting the proposed pathophysiology of DPN are being developed.
糖尿病周围神经病变（DPN）传统上分为大纤维神经病（SFN）和小纤维神经病（SFN）。神经传导研究（NCS）可检测到大纤维的损伤，通常导致感觉灵敏度显著降低和保护性感觉丧失，而小纤维的损伤则难以可靠检测，可能无症状，与对有害刺激不敏感有关，或常表现为难治性神经痛。
描述 DPN 的检测、分级和治疗的最新进展，以及伴随的神经痛。
我们检索了 MEDLINE、EMBASE 和 Cochrane Library 上 1967 年 1 月 1 日至 2020 年 1 月 1 日之间的相关同行评议英文文献。
我们发现了 300 多篇关于检测和分级 DPN 的方法的研究，以及 80 多项治疗糖尿病性神经痛的随机对照试验。
NCS 仍然是检测糖尿病患者 LFN 的首选方法，而 SFN 的检测金标准尚未在国际上得到认可。近年来，一些具有巨大潜力的检测和分级该疾病的方法已经出现，包括皮肤活检和角膜共聚焦显微镜，这些方法在未来可能代表临床研究的可靠终点。虽然已经开发出几种用于检测 SFN 的新方法，但还没有新的药物被用于治疗糖尿病患者的神经痛。三环类抗抑郁药、5-羟色胺去甲肾上腺素再摄取抑制剂和抗惊厥药仍然是一线治疗药物，而针对 DPN 拟议病理生理学的新型药物正在开发中。
