Røikjer Johan, Borbjerg Mette Krabsmark, Andresen Trine, Giordano Rocco, Hviid Claus Vinter Bødker, Mørch Carsten Dahl, Karlsson Pall, Klonoff David C, Arendt-Nielsen Lars, Ejskjaer Niels
Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark.
Integrative Neuroscience, Aalborg University, Aalborg, Denmark.
J Diabetes Sci Technol. 2024 Sep 16:19322968241279553. doi: 10.1177/19322968241279553.
Diabetic peripheral neuropathy (DPN) is a prevalent and debilitating complication of diabetes, often leading to severe neuropathic pain. Although other diabetes-related complications have witnessed a surge of emerging treatments in recent years, DPN has seen minimal progression. This stagnation stems from various factors, including insensitive diagnostic methods and inadequate treatment options for neuropathic pain.
In this comprehensive review, we highlight promising novel diagnostic techniques for assessing DPN, elucidating their development, strengths, and limitations, and assessing their potential as future reliable clinical biomarkers and endpoints. In addition, we delve into the most promising emerging pharmacological and mechanistic treatments for managing neuropathic pain, an area currently characterized by inadequate pain relief and a notable burden of side effects.
Skin biopsies, corneal confocal microscopy, transcutaneous electrical stimulation, blood-derived biomarkers, and multi-omics emerge as some of the most promising new techniques, while low-dose naltrexone, selective sodium-channel blockers, calcitonin gene-related peptide antibodies, and angiotensin type 2 receptor antagonists emerge as some of the most promising new drug candidates.
Our review concludes that although several promising diagnostic modalities and emerging treatments exist, an ongoing need persists for the further development of sensitive diagnostic tools and mechanism-based, personalized treatment approaches.
糖尿病周围神经病变（DPN）是糖尿病常见且使人衰弱的并发症，常导致严重的神经性疼痛。尽管近年来其他与糖尿病相关的并发症出现了大量新的治疗方法，但DPN的进展甚微。这种停滞源于多种因素，包括诊断方法不敏感以及神经性疼痛的治疗选择不足。
在这篇全面综述中，我们重点介绍了用于评估DPN的有前景的新型诊断技术，阐明了它们的发展、优势和局限性，并评估了它们作为未来可靠的临床生物标志物和终点指标的潜力。此外，我们深入探讨了用于治疗神经性疼痛的最有前景的新兴药理学和机制性治疗方法，目前该领域存在疼痛缓解不足和副作用负担显著的问题。
皮肤活检、角膜共焦显微镜检查、经皮电刺激、血液衍生生物标志物和多组学技术成为一些最有前景的新技术，而低剂量纳曲酮、选择性钠通道阻滞剂、降钙素基因相关肽抗体和血管紧张素2型受体拮抗剂成为一些最有前景的新候选药物。
我们的综述得出结论，尽管存在几种有前景的诊断方法和新兴治疗方法，但仍持续需要进一步开发敏感的诊断工具以及基于机制的个性化治疗方法。
