Carvajal-Moreno Lidia, Coheña-Jiménez Manuel, García-Ventura Irene, Pabón-Carrasco Manuel, Pérez-Belloso Ana Juana
Department of Podiatry, University of Seville, 41009 Seville, Spain.
Spanish Red Cross Nursing School, University of Seville, Avda. de la Cruz Roja, nº 1 Dpdo., 41009 Seville, Spain.
J Clin Med. 2022 Mar 21;11(6):1723. doi: 10.3390/jcm11061723.
Background: Diabetic peripheral neuropathy (DPN) is the most frequent chronic complication and is that which generates the highest disability and mortality in diabetes mellitus (DM). As it is currently the only microvascular complication of DM without a specific treatment, prevention is essential. The aim of this study was to determine the most effective preventive strategy to avoid or delay the appearance and/or development of DPN in patients with DM. Methods: A systematic search was carried out in the main health science databases (PubMed, Scopus, CINAHL, PEDro and The Cochrane Library) from 1 January 2010 to 31 August 2020. The study selection was conducted by two independent reviewers and data extraction was performed by the author. The eligibility criteria included randomized clinical trials (RCTs) and cohort studies from RCTs. Results: Eleven studies were selected that included 23,595 participants with DM. The interventions evaluated were intensive or standard glycemic control, the use of drugs to achieve glycemic control, and the promotion of a healthy lifestyle and exercise. Intensive glucose control achieved a significant reduction in the development of DPN in TIDM patients, and lifestyle modifications and exercise achieved it moderately in TIIDM patients. Conclusions: The main preventive strategy for DPN is intensive glycemic control with a target HbA1c < 6% in patients with TIDM and standard control of 7.0−7.9 in patients with TIIDM, incorporating lifestyle modifications.
糖尿病周围神经病变（DPN）是最常见的慢性并发症，也是糖尿病（DM）中导致最高残疾率和死亡率的并发症。由于它是目前DM唯一没有特效治疗方法的微血管并发症，预防至关重要。本研究的目的是确定最有效的预防策略，以避免或延缓DM患者中DPN的出现和/或发展。方法：在2010年1月1日至2020年8月31日期间，对主要健康科学数据库（PubMed、Scopus、CINAHL、PEDro和Cochrane图书馆）进行了系统检索。研究选择由两名独立评审员进行，数据提取由作者完成。纳入标准包括随机临床试验（RCT）和来自RCT的队列研究。结果：选择了11项研究，包括23595名DM患者。评估的干预措施包括强化或标准血糖控制、使用药物实现血糖控制以及促进健康的生活方式和运动。强化血糖控制在1型糖尿病（TIDM）患者中显著降低了DPN的发生，生活方式改变和运动在2型糖尿病（TIIDM）患者中适度降低了DPN的发生。结论：DPN的主要预防策略是，对于TIDM患者，强化血糖控制目标为糖化血红蛋白（HbA1c）<6%，对于TIIDM患者，标准控制目标为7.0−7.9，并结合生活方式改变。
