Continuum (Minneap Minn). 2020 Oct;26(5):1161-1183. doi: 10.1212/CON.0000000000000906.
This article provides an up-to-date review of the manifestations of neuropathy seen in the setting of diabetes and other metabolic disorders.
Although a number of metabolic disorders cause or are associated with peripheral neuropathy, the neuropathies associated with glucose dysregulation make up the vast majority of cases. Recent investigations have determined major differences in the neuropathies associated with type 1 and type 2 diabetes. Neuropathy in type 1 diabetes is closely linked to glycemic control, whereas neuropathy in type 2 diabetes is linked to dyslipidemia, central obesity, hypertension, insulin resistance, and glucose control. Although length-dependent axonal distal symmetric polyneuropathy is the most common clinical presentation, diabetes is also associated with acute, asymmetric, painless, and autonomic neuropathies.
The prevalence of diabetes and metabolic syndrome is increasing across the globe. The need to recognize and treat the wide array of clinical manifestations of neuropathy detected in individuals with metabolic disorders will continue to grow. As a consequence, an increasing number of well-trained physicians who can manage these patients is needed. At present, treatment is largely focused on prevention and symptomatic management. Investments into funding for both basic and clinical science are necessary to bring novel therapeutic interventions into clinical practice.
本文对糖尿病和其他代谢紊乱相关神经病的表现进行了最新综述。
尽管许多代谢紊乱可引起或与周围神经病相关，但与葡萄糖调节相关的神经病占绝大多数。最近的研究发现，1 型和 2 型糖尿病相关的神经病存在显著差异。1 型糖尿病相关的神经病与血糖控制密切相关，而 2 型糖尿病相关的神经病与血脂异常、中心性肥胖、高血压、胰岛素抵抗和血糖控制有关。虽然长度依赖性轴索性远端对称性多发性神经病是最常见的临床表现，但糖尿病也与急性、不对称性、无痛性和自主神经病相关。
全球范围内糖尿病和代谢综合征的患病率正在增加。需要识别和治疗代谢紊乱患者中发现的多种临床表现的神经病，这一需求将会持续增长。因此，需要更多训练有素的医生来管理这些患者。目前，治疗主要集中在预防和对症治疗上。为基础和临床科学提供资金投入对于将新的治疗干预措施引入临床实践是必要的。
