New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine.

Heng Yang,Shuo Wang,Gordon Sloan,Bihan Duan,Ling Gao,Solomon Tesfaye,Yingchun Ye

doi:10.3389/fendo.2019.00929

Abstract

Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. It leads to distressing and expensive clinical sequelae such as foot ulceration, leg amputation, and neuropathic pain (painful-DPN). Unfortunately, DPN is often diagnosed late when irreversible nerve injury has occurred and its first presentation may be with a diabetic foot ulcer. Several novel diagnostic techniques are available which may supplement clinical assessment and aid the early detection of DPN. Moreover, treatments for DPN and painful-DPN are limited. Only tight glucose control in type 1 diabetes has robust evidence in reducing the risk of developing DPN. However, neither glucose control nor pathogenetic treatments are effective in painful-DPN and symptomatic treatments are often inadequate. It has recently been hypothesized that using various patient characteristics it may be possible to stratify individuals and assign them targeted therapies to produce better pain relief. We review the diagnostic techniques which may aid the early detection of DPN in the clinical and research environment, and recent advances in precision medicine techniques for the treatment of painful-DPN.

Highlights

Neuropathic syndromes are common complications of diabetes mellitus
We review the recent advances in the diagnosis of diabetic peripheral sensorimotor neuropathy (DPN), which may supplement clinical assessment and could aid the early detection of DPN in the clinical and research environments, and precision medicine techniques, which may be used to improve the treatment of painful-DPN in the future
The prevalence of diabetes mellitus is rising to epidemic proportions

Summary

INTRODUCTION

By far the most prevalent is chronic diabetic peripheral sensorimotor neuropathy (DPN), affecting up to 50% of people with diabetes [1, 2]. DPN is associated with increased mortality and leads to morbidity, principally as a result of its two major clinical consequences, diabetic foot ulceration, and neuropathic pain [3,4,5]. Diabetic foot ulceration occurs as a result of a complex interaction of risk factors and patient behaviors, but sensory loss secondary to DPN is most often the primary cause [6]. Typical DPN is by far the most prevalent form of neuropathy in diabetes and characteristically affects both sensory and motor nerves in a peripheral distribution [1]. The Toronto Diabetic Neuropathy Expert Group defined DPN as “a symmetrical, length dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure (DM) and cardiovascular risk covariates [16].”

Diffuse neuropathy DSPN

Findings

CONCLUSIONS