Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK.
Nat Rev Endocrinol. 2021 Jul;17(7):400-420. doi: 10.1038/s41574-021-00496-z. Epub 2021 May 28.
Diabetic sensorimotor peripheral neuropathy (DSPN) is a serious complication of diabetes mellitus and is associated with increased mortality, lower-limb amputations and distressing painful neuropathic symptoms (painful DSPN). Our understanding of the pathophysiology of the disease has largely been derived from animal models, which have identified key potential mechanisms. However, effective therapies in preclinical models have not translated into clinical trials and we have no universally accepted disease-modifying treatments. Moreover, the condition is generally diagnosed late when irreversible nerve damage has already taken place. Innovative point-of-care devices have great potential to enable the early diagnosis of DSPN when the condition might be more amenable to treatment. The management of painful DSPN remains less than optimal; however, studies suggest that a mechanism-based approach might offer an enhanced benefit in certain pain phenotypes. The management of patients with DSPN involves the control of individualized cardiometabolic targets, a multidisciplinary approach aimed at the prevention and management of foot complications, and the timely diagnosis and management of neuropathic pain. Here, we discuss the latest advances in the mechanisms of DSPN and painful DSPN, originating both from the periphery and the central nervous system, as well as the emerging diagnostics and treatments.
糖尿病感觉运动周围神经病（DSPN）是糖尿病的一种严重并发症，与死亡率增加、下肢截肢和令人痛苦的神经性疼痛症状（痛性 DSPN）有关。我们对该疾病病理生理学的理解主要来自于动物模型，这些模型已经确定了关键的潜在机制。然而，临床前模型中的有效疗法并未转化为临床试验，我们也没有普遍接受的疾病修正治疗方法。此外，当已经发生不可逆转的神经损伤时，该疾病通常被诊断得较晚。创新的即时护理设备具有很大的潜力，可以在疾病更易于治疗时实现 DSPN 的早期诊断。痛性 DSPN 的治疗仍然不尽如人意；然而，研究表明，基于机制的方法可能会在某些疼痛表型中提供更好的效果。DSPN 患者的管理涉及个体化的心血管代谢目标的控制、旨在预防和管理足部并发症的多学科方法，以及神经病理性疼痛的及时诊断和管理。在这里，我们讨论了源自外周和中枢神经系统的 DSPN 和痛性 DSPN 的最新发病机制的进展，以及新兴的诊断和治疗方法。
