Panou Theodoros, Gouveri Evanthia, Popovic Djordje S, Papazoglou Dimitrios, Papanas Nikolaos
Diabetes Centre, Second Department of Internal Medicine, Democritus University of Thrace, Alexandroupolis, Greece.
Clinic for Endocrinology, Diabetes and Metabolic Disorders, Clinical Centre of Vojvodina, Medical Faculty, University of Novi Sad, Novi Sad, Serbia.
Diabetes Ther. 2025 Jun;16(6):1077-1105. doi: 10.1007/s13300-025-01712-z. Epub 2025 Mar 28.
Diabetic peripheral neuropathy (DPN) is one of the commonest complications of diabetes mellitus (DM). Current therapeutic approaches largely focus on pain management. However, less evidence is available on the clinical potential of two widely prescribed drug categories in DM management: dipeptidyl peptidase 4 inhibitors (DPP-4is) and glucagon-like peptide-1 receptor agonists (GLP-1RAs). In this review, we discuss evidence from both experimental and clinical studies on the potential utility of these drugs in the management of DPN. Immunohistochemical data indicate that agents in both categories promote neurite outgrowth, ion conduction, neuronal survival and Schwann cell function. Furthermore, intra-epidermal nerve fibre density has been reported to increase with DPP-4is or GLP-1RAs treatment. Moreover, electrophysiological studies have indicated a diverse, but mostly beneficial, effect on motor or sensory nerve conduction velocity. Clinical tests, such as the muscular grip or paw jumping control resembling neuropathic symptoms, have also confirmed the advantageous effect of DPP-4is and GLP-1RAs. Finally, limited but promising clinical data have shown improved somatosensory-evoked potentials and vibration perception threshold, as well as restored excitability and nerve size parameters. Nevertheless, further clinical studies are required to elucidate the exact role of DPP-4is and GLP-1RAs in DPN.
糖尿病周围神经病变（DPN）是糖尿病（DM）最常见的并发症之一。目前的治疗方法主要集中在疼痛管理上。然而，关于糖尿病管理中两类广泛使用的药物：二肽基肽酶4抑制剂（DPP - 4is）和胰高血糖素样肽 - 1受体激动剂（GLP - 1RAs）的临床潜力，现有证据较少。在本综述中，我们讨论了来自实验和临床研究的证据，这些证据表明这些药物在DPN管理中的潜在效用。免疫组织化学数据表明，这两类药物都能促进神经突生长、离子传导、神经元存活和雪旺细胞功能。此外，据报道，DPP - 4is或GLP - 1RAs治疗可增加表皮内神经纤维密度。此外，电生理研究表明，它们对运动或感觉神经传导速度有多种影响，但大多是有益的。诸如类似于神经病变症状的肌肉握力或爪跳控制等临床试验也证实了DPP - 4is和GLP - 1RAs的有益效果。最后，有限但有前景的临床数据表明，体感诱发电位和振动感觉阈值有所改善，兴奋性和神经大小参数也得以恢复。然而，需要进一步的临床研究来阐明DPP - 4is和GLP - 1RAs在DPN中的确切作用。
