Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany.
Department of Endocrinology, Medical Faculty and University Hospital, Heinrich Heine University, Düsseldorf, Germany.
Curr Diabetes Rev. 2022;18(5):e120421192781. doi: 10.2174/1573399817666210412123740.
The various manifestations of diabetic neuropathy, including distal symmetric sensorimotor polyneuropathy (DSPN) and cardiovascular autonomic neuropathy (CAN), are among the most prevalent chronic complications of diabetes. Major clinical complications of diabetic neuropathies, such as neuropathic pain, chronic foot ulcers, and orthostatic hypotension, are associated with considerable morbidity, increased mortality, and diminished quality of life. Despite the substantial individual and socioeconomic burden, the strategies to diagnose and treat diabetic neuropathies remain insufficient. This review provides an overview of the current clinical aspects and recent advances in exploring local and systemic biomarkers of both DSPN and CAN assessed in human studies (such as biomarkers of inflammation and oxidative stress) for better understanding of the underlying pathophysiology and for improving early detection. Current therapeutic options for DSPN are (I) causal treatment, including lifestyle modification, optimal glycemic control, and multifactorial risk intervention, (II) pharmacotherapy derived from pathogenetic concepts, and (III) analgesic treatment against neuropathic pain. Recent advances in each category are discussed, including non-pharmacological approaches, such as electrical stimulation. Finally, the current therapeutic options for cardiovascular autonomic complications are provided. These insights should contribute to a broader understanding of the various manifestations of diabetic neuropathies from both the research and clinical perspectives.
糖尿病神经病变的各种表现形式，包括远端对称性感觉运动多发性神经病（DSPN）和心血管自主神经病（CAN），是糖尿病最常见的慢性并发症之一。糖尿病神经病变的主要临床并发症，如神经性疼痛、慢性足部溃疡和直立性低血压，与相当大的发病率、死亡率增加和生活质量下降有关。尽管个人和社会经济负担巨大，但诊断和治疗糖尿病神经病变的策略仍然不足。这篇综述概述了当前临床方面和最近在探索人类研究中 DSPN 和 CAN 的局部和系统生物标志物方面的进展（如炎症和氧化应激的生物标志物），以便更好地了解潜在的病理生理学，并改善早期检测。DSPN 的当前治疗选择包括：（I）病因治疗，包括生活方式改变、最佳血糖控制和多因素风险干预，（II）基于发病机制概念的药物治疗，以及（III）针对神经性疼痛的镇痛治疗。讨论了每一类别的最新进展，包括电刺激等非药物治疗方法。最后提供了心血管自主并发症的当前治疗选择。这些见解应有助于从研究和临床角度更全面地了解糖尿病神经病变的各种表现。
