Department for Endocrinology, Diabetology, Metabolic Diseases and Clinical Chemistry, University Hospital Heidelberg, Heidelberg, Germany.
German Center for Diabetes Research, Munich-Neuherberg, Germany.
Diabetes. 2024 Jan 1;73(1):135-146. doi: 10.2337/db23-0271.
We aimed to investigate the characteristics and longitudinal course of sensory phenotypes identified through quantitative sensory testing (QST) in the frame of diabetic sensorimotor polyneuropathy (DSPN). A total of 316 individuals with diabetes were examined (type 2 diabetes 78.8%), 250 of whom were undergoing follow-up visits at 1, 2, and/or 4 (2.88 ± 1.27) years. Allocation into four sensory phenotypes (healthy, thermal hyperalgesia [TH], mechanical hyperalgesia [MH], and sensory loss [SL]) at every time point was based on QST profiles of the right foot. Cross-sectional analysis demonstrated a gradual worsening of clinical and electrophysiological sensory findings and increased DSPN prevalence across the groups, culminating in SL. Motor nerve impairment was observed solely in the SL group. Longitudinal analysis revealed a distinct pattern in the developmental course of the phenotype (from healthy to TH, MH, and finally SL). Those with baseline MH exhibited the highest risk of transition to SL. Reversion to healthy status was uncommon and mostly observed in the TH group. Among those without DSPN initially, presence or future occurrence of SL was associated with a three- to fivefold higher likelihood of DSPN development. Our comprehensive longitudinal study of phenotyped patients with diabetes elucidates the natural course of DSPN. QST-based sensory examination together with other tools for phenotyping may be useful in determining the natural course of diabetic neuropathy to identify patients at high risk of DSPN and guide preventive and therapeutic interventions.
The course of diabetic sensorimotor polyneuropathy (DSPN) development, from healthy status to overt DSPN, is poorly understood. We studied the characteristics and longitudinal appearance of lower-extremity sensory phenotypes (healthy, thermal hyperalgesia [TH], mechanical hyperalgesia [MH], and sensory loss [SL]) identified through quantitative sensory testing in individuals with diabetes. There was an increasing severity and patterned order of longitudinal appearance across healthy, TH, MH, and SL phenotypes. SL was most strongly associated with formal DSPN. Our findings provide insight into the natural history of DSPN. Sensory phenotyping can be implemented to identify high-risk individuals and those most likely to benefit from therapeutic interventions.
本研究旨在通过定量感觉测试（QST）探讨糖尿病感觉运动性多发性神经病（DSPN）患者的感觉表型特征及其纵向病程。
共纳入 316 例糖尿病患者（2 型糖尿病占 78.8%），其中 250 例在 1、2 和/或 4 年（2.88±1.27 年）时进行了随访。在每个时间点，根据右脚 QST 谱将患者分为 4 种感觉表型（健康、热痛觉过敏 [TH]、机械痛觉过敏 [MH]和感觉缺失 [SL]）。横断面分析显示，临床和电生理感觉检查结果逐渐恶化，DSPN 患病率在各亚组中逐渐升高，最终发展为 SL。仅在 SL 组观察到运动神经损伤。纵向分析显示，表型的发展过程具有明显的特征（从健康到 TH、MH，最终发展为 SL）。基线时存在 MH 的患者向 SL 转化的风险最高。恢复至健康状态并不常见，主要见于 TH 组。在最初无 DSPN 的患者中，SL 的出现或未来发生与 DSPN 发展的风险增加 3-5 倍相关。本研究对糖尿病患者进行了全面的纵向表型研究，阐明了 DSPN 的自然病程。基于 QST 的感觉检查与其他表型鉴定工具结合使用，可能有助于确定糖尿病神经病变的自然病程，从而识别出有 DSPN 高危风险的患者，并指导预防和治疗干预。
从健康状态到明显的 DSPN，糖尿病感觉运动性多发性神经病（DSPN）的发展过程仍不清楚。我们通过定量感觉测试（QST）研究了糖尿病患者下肢感觉表型（健康、热痛觉过敏 [TH]、机械痛觉过敏 [MH]和感觉缺失 [SL]）的特征及其纵向表现。在健康、TH、MH 和 SL 表型中，纵向表现的严重程度和顺序逐渐增加。SL 与正式的 DSPN 关系最密切。我们的研究结果提供了对 DSPN 自然病史的深入了解。感觉表型可用于识别高危人群和最有可能从治疗干预中获益的人群。
