PDF(Pubmed)
Abstract：
Long term consequences of diabetes mellitus (DM) may include multi-organ complications such as retinopathy, cardiovascular disease, neuronal, and kidney damage. One of the most prevalent complication is diabetic peripheral neuropathy (DPN), occurring in half of all diabetics, and is the main cause of disability globally with profound impact on a patient\'s quality of life. Small fiber neuropathy (SFN) can develop in the pre-diabetes stage preceding large fiber damage in DPN. Asymptomatic SFN is difficult to diagnose in early stages, with sudomotor dysfunction considered one of the earliest manifestations of autonomic neuropathy. Early detection is crucial as it can prevent potential cardiovascular events. Although punch skin biopsy is the gold-standard method for SFN diagnosis, implementation as routine screening is hindered due to its invasive, impractical, and time-consuming nature. Other sudomotor testing modalities, most of which evaluate the postganglionic cholinergic sympathetic nervous system, have been developed with varying sensitivity and specificity for SFN diagnosis. Here, we provide an overview on the general mechanism of DPN, the importance of sudomotor assessment for early detection of autonomic dysfunction in DPN, the benefits and disadvantages of current testing modalities, factors that may affect testing, and the importance of future discoveries on sudomotor testing for successful DPN diagnosis.
摘要：
糖尿病（DM）的长期后果可能包括多器官并发症，如视网膜病变，心血管疾病,神经元，和肾脏损伤。最常见的并发症之一是糖尿病周围神经病变（DPN），发生在一半的糖尿病患者中，并且是全球残疾的主要原因，对患者的生活质量产生深远的影响。在DPN中的大纤维损伤之前,小纤维神经病变(SFN)可以在糖尿病前期发展。无症状的SFN很难在早期诊断，sudomotor功能障碍被认为是自主神经病变的最早表现之一。早期检测至关重要，因为它可以预防潜在的心血管事件。尽管穿刺皮肤活检是SFN诊断的金标准方法，由于其侵入性，常规筛查的实施受到阻碍，不切实际，和耗时的性质。其他sudomotor测试模式，其中大多数评估节后胆碱能交感神经系统，已经开发出具有不同灵敏度和特异性的SFN诊断。这里,我们概述了DPN的一般机制，sudomotor评估对早期发现DPN自主神经功能障碍的重要性，当前测试模式的利弊，可能影响测试的因素，以及未来在sudomotor测试中发现对成功诊断DPN的重要性。
