Preston Frank G, Riley David R, Azmi Shazli, Alam Uazman
Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK.
Institute of Cardiovascular Science, University of Manchester and Manchester Diabetes Centre, Manchester Foundation Trust, Manchester, UK.
Diabetes Metab Syndr Obes. 2023 Jun 2;16:1595-1612. doi: 10.2147/DMSO.S370050. eCollection 2023.
Painful diabetic peripheral neuropathy (PDPN) is present in nearly a quarter of people with diabetes. It is estimated to affect over 100 million people worldwide. PDPN is associated with impaired daily functioning, depression, sleep disturbance, financial instability, and a decreased quality of life. Despite its high prevalence and significant health burden, it remains an underdiagnosed and undertreated condition. PDPN is a complex pain phenomenon with the experience of pain associated with and exacerbated by poor sleep and low mood. A holistic approach to patient-centred care alongside the pharmacological therapy is required to maximise benefit. A key treatment challenge is managing patient expectation, as a good outcome from treatment is defined as a reduction in pain of 30-50%, with a complete pain-free outcome being rare. The future for the treatment of PDPN holds promise, despite a 20-year void in the licensing of new analgesic agents for neuropathic pain. There are over 50 new molecular entities reaching clinical development and several demonstrating benefit in early-stage clinical trials. We review the current approaches to its diagnosis, the tools, and questionnaires available to clinicians, international guidance on PDPN management, and existing pharmacological and non-pharmacological treatment options. We synthesise evidence and the guidance from the American Association of Clinical Endocrinology, American Academy of Neurology, American Diabetes Association, Diabetes Canada, German Diabetes Association, and the International Diabetes Federation into a practical guide to the treatment of PDPN and highlight the need for future research into mechanistic-based treatments in order to prioritise the development of personalised medicine.
疼痛性糖尿病周围神经病变（PDPN）在近四分之一的糖尿病患者中存在。据估计，全球有超过1亿人受其影响。PDPN与日常功能受损、抑郁、睡眠障碍、经济不稳定以及生活质量下降有关。尽管其患病率高且对健康负担重大，但它仍然是一种诊断不足和治疗不足的病症。PDPN是一种复杂的疼痛现象，疼痛体验与睡眠不佳和情绪低落有关且会因之加剧。需要采用以患者为中心的整体护理方法并结合药物治疗，以实现最大益处。一个关键的治疗挑战是管理患者的期望，因为治疗的良好结果定义为疼痛减轻30 - 50%，完全无痛的结果很少见。尽管用于神经性疼痛的新镇痛药在过去20年中一直未获批准，但PDPN的治疗前景依然乐观。有50多种新的分子实体进入临床开发阶段，其中一些在早期临床试验中显示出疗效。我们回顾了其目前的诊断方法、临床医生可用的工具和问卷、PDPN管理的国际指南以及现有的药物和非药物治疗选择。我们综合了美国临床内分泌学会、美国神经病学学会、美国糖尿病协会、加拿大糖尿病协会、德国糖尿病协会和国际糖尿病联盟的证据和指南，形成了一份PDPN治疗实用指南，并强调了未来对基于机制的治疗进行研究的必要性，以便优先发展个性化医疗。
