Inflammatory biomarkers as a part of diagnosis in diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN), a chronic neurological complication of diabetes mellitus, remains scantily addressed area of research. Many lacunae in the temporal sequence between cause and effect of DPN still remain unfilled and therefore treatment of DPN remains unsatisfactory. This is largely due to the conventional glucocentric focus to resolve the problem. This focus over hyperglycemia should be shifted to consider, chronic low grade inflammation as the major determinant in DPN. Rapidly emerging evidences from recent studies suggest that chronic low grade inflammation leads to the activation of innate immune system response, loss of insulin signaling and insulin resistance, endoplasmic reticulum stress, mitochondrial stress, leading to production of kinases like protein kinase C, mitogen activated protein kinase and jun-N-terminal kinase, pro-inflammatory cytokines and inter leukins-1b, 2, 6 and 8, tumour necrosis factor-alpha and other chemokines, leading to DPN. These biomarkers can be early predictors of DPN and therefore should be the focus of work testing their clinical utility to identify high-risk individuals as well as perhaps to target interventions. In this paper, we would like to review all the aspects of DPN, laying greater emphasis on inflammatory biomarkers as a tool for early diagnosis of DPN and the possible research approaches to address it satisfactorily.