Diabetic neuropathy: Pathogenesis and evolving principles of management

Area of Science:

• Endocrinology
• Neurology
• Metabolic Diseases

Background:

• The global increase in prediabetes and diabetes has led to a rise in associated complications, most commonly neuropathy.
• Diabetic neuropathy (DN), particularly distal symmetric polyneuropathy (DSP), is a prevalent and debilitating complication of diabetes mellitus, causing significant morbidity, mortality, and financial burden.
• Characterized by sensory loss in the lower limbs and discomfort, DN affects at least 50% of individuals with diabetes over time.

Purpose of the Study:

• To explore the complexities of diabetic neuropathy, including its origins and potential new prevention and treatment strategies.
• To address the need for improved understanding of the distinct mechanisms driving neuropathy in type 1 and type 2 diabetes.
• To identify unrecognized modifiable risk factors for diabetic DSP in the absence of disease-modifying therapies.

Main Methods:

• Review of current clinical evaluations and therapeutic options for diabetic peripheral neuropathy.
• Analysis of the impact of glycemic control on neuropathy progression in type 1 and type 2 diabetes.
• Examination of evidence supporting pharmacological treatments for painful DN, including anticonvulsants and antidepressants.

Main Results:

• Good glycemic control effectively halts neuropathy progression in type 1 diabetes but has a considerably lower effect in type 2 diabetes.
• Anticonvulsants and antidepressants are supported by evidence for treating painful diabetic peripheral neuropathy.
• Despite advancements, the unique processes underlying neuropathy in type 1 and type 2 diabetes remain unclear, and disease-modifying medications are lacking.

Conclusions:

• Current effective therapies for diabetic neuropathy are limited to glycemic control and pain management.
• The identification of 'missed' modifiable risk factors is imperative for developing comprehensive, individualized care and novel therapeutic targets.
• Further research is needed to elucidate the specific mechanisms of DN in different diabetes types and to develop disease-modifying treatments.