Diabetic Neuropathies: Diagnosis and Management

被引:145
作者
Deli, Gabriella [1 ]
Bosnyak, Edit [1 ]
Pusch, Gabriella [1 ,2 ]
Komoly, Samuel [1 ]
Feher, Gergely [1 ,2 ]
机构
[1] Univ Pecs, Dept Neurol, Pecs, Hungary
[2] East Kent Hosp Univ NHS Fdn Trust, William Harvey Hosp, Ashford TN24 0LZ, Kent, England
关键词
Diabetes; PolyneuropathyNeuropathy; Diagnosis; Treatment; Neuropathic pain; Sensory neuropathy; Autonomic neuropathy; ALPHA-LIPOIC ACID; ALDOSE REDUCTASE INHIBITOR; PERIPHERAL NEUROPATHY; DOUBLE-BLIND; PHARMACOLOGICAL-TREATMENT; AUTONOMIC NEUROPATHY; ERECTILE DYSFUNCTION; ANTIEPILEPTIC DRUGS; CLINICAL-EFFICACY; OXIDATIVE STRESS;
D O I
10.1159/000358728
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Changes in human behaviour and lifestyle over the last century have resulted in a dramatic increase in the incidence of diabetes worldwide. Neuropathy is a common and costly complication of both type 1 and type 2 diabetes. The prevalence of neuropathy is estimated to be about 8% in newly diagnosed patients and greater than 50% in patients with long-standing disease. There are two main types of diabetic neuropathies, named as sensorimotor and autonomic neuropathies. Sensorinnotor neuropathy is marked by pain, paraesthesia and sensory loss, and autonomic neuropathy may contribute to myocardial infarction, malignant arrhythmia and sudden death. Methods: In this article we reviewed the pathogenesis, clinical manifestations diagnosis and treatment of diabetic neuropathies. Conclusion: Sensorimotor and autonomic neuropathies (cardiovascular, gastrointestinal and genitourinary autonomic neuropathies) are common in diabetic patients. Apart from strict glycaemic control, no further therapeutic approach exists in the prevention of this phenomenon. Intensive diabetes therapy, intensive multifactorial cardiovascular risk reduction and lifestyle intervention are recommended in patients with cardiovascular autonomic neuropathy. Gastroparesis is the most debilitating complication of gastrointestinal autonomic neuropathy and genitourinary autonomic neuropathy can cause sexual dysfunction and neurogenic bladder; these conditions are hard to manage. The symptomatic treatment of sensory symptoms includes tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, gabapentin, pregabalin and opioids. Other treatment strategies are not so effective. (C) 2014 S. Karger AG, Basel
引用
收藏
页码:267 / 280
页数:14
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