Diabetic peripheral neuropathy: research and therapy
Song Hehua, Wei Zairong
Department of Burn and Plastic Surgery, The Affiliated Hospital of Zunyi Medical University, Zunyi 563003, Guizhou Province, China
Abstract: BACKGROUND: Diabetic peripheral neuropathy has a high disability rate and is one of the most common chronic complications of diabetes. Because its pathogenesis is complex and diverse, there is no recognized treatment method currently. It is a challenge to treat and manage this chronic disease. However, there are few reviews in this area.
OBJECTIVE: To explore the related pathogenesis of diabetic peripheral neuropathy and to review the application effect of different treatment methods in diabetic peripheral neuropathy.
METHODS: The first author searched the relevant literature in CNKI, WanFang and PubMed databases. The Chinese search terms were “diabetic peripheral neuropathy, diabetic complications, pathogenesis, diagnosis, treatment, Chinese medicine, surgical treatment, surgery, electrical stimulation, nerve release, nerve decompression” and the English search terms were “DPN, diabetic peripheral neuropathy, pathogenesis, diagnosis, therapy, treatment, drug, surgery, nerve decompression, nerve electrical stimulation, gene, exosome.” The literature search time was limited from January 2000 to January 2022. The literature was initially screened by reading the abstracts of the articles and those unrelated to the theme of the article were excluded. Finally 88 articles were included for review.
RESULTS AND CONCLUSION: Hyperglycemia is the root cause of diabetic peripheral neuropathy. Strengthening blood sugar control is the most basic and important step in the treatment of diabetic peripheral neuropathy. Analgesic drugs can significantly reduce pain symptoms of patients with diabetic peripheral neuropathy. α-Lipoic acid and epalrestat play an anti-oxidative stress role; mecobalamin and nerve growth factor can promote the recovery of nerve function. According to the pathogenesis of “double extrusion” of diabetic peripheral neuropathy, nerve decompression and nerve transferring can reduce the degree of neuropathy, relieve pain and increase nerve conduction velocity in patients with diabetic peripheral neuropathy. Gene and stem cell therapies are promising new therapies. They are targeted, but relevant clinical studies are currently lacking and there are also concerns on ethical and safety issues.
Key words: diabetic peripheral neuropathy, pathogenesis, diagnosis, treatment, nerve mobilization, nerve decompression