PDF(Pubmed)
Abstract：
The proposed expert opinion aimed to address the current knowledge on conceptual, clinical, and therapeutic aspects of diabetic peripheral neuropathy (DPN) and to provide a guidance document to assist clinicians for the best practice in DPN care. The participating experts consider the suspicion of the disease by clinicians as a key factor in early recognition and diagnosis, emphasizing an improved awareness of the disease by the first-admission or referring physicians. The proposed \"screening and diagnostic\" algorithm involves the consideration of DPN in a patient with prediabetes or diabetes who presents with neuropathic symptoms and/or signs of neuropathy in the presence of DPN risk factors, with careful consideration of laboratory testing to rule out other causes of distal symmetric peripheral neuropathy and referral for a detailed neurological work-up for a confirmative test of either small or large nerve fiber dysfunction in atypical cases. Although, the first-line interventions for DPN are currently represented by optimized glycemic control (mainly for type 1 diabetes) and multifactorial intervention (mainly for type 2 diabetes), there is a need for individualized pathogenesis-directed treatment approaches for DPN. Alpha-lipoic acid (ALA) seems to be an important first-line pathogenesis-directed agent, given that it is a direct and indirect antioxidant that works with a strategy targeted directly against reactive oxygen species and indirectly in favor of endogenous antioxidant capacity for improving DPN conditions. There is still a gap in existing research in the field, necessitating well-designed, robust, multicenter clinical trials with sensitive endpoints and standardized protocols to facilitate the diagnosis of DPN via a simple and effective algorithm and to track progression of disease and treatment response. Identification of biomarkers/predictors that would allow an individualized approach from a potentially disease-modifying perspective may provide opportunities for novel treatments that would be efficacious in early stages of DPN, and may modify the natural course of the disease. This expert opinion document is expected to increase awareness among physicians about conceptual, clinical, and therapeutic aspects of DPN and to assist them in timely recognition of DPN and translating this information into their clinical practice for best practice in the management of patients with DPN.
摘要：
拟议的专家意见旨在解决当前关于概念、临床,糖尿病周围神经病变（DPN）的治疗方面，并提供指导文件，以协助临床医生制定DPN护理的最佳实践。与会专家认为临床医生对该病的怀疑是早期识别和诊断的关键因素，强调首次入院或转诊的医生提高对疾病的认识。拟议的“筛查和诊断”算法涉及在糖尿病前期或糖尿病患者中考虑DPN，这些患者在存在DPN危险因素的情况下表现出神经病变症状和/或神经病变体征。仔细考虑实验室检查以排除远端对称性周围神经病的其他原因，并转诊进行详细的神经系统检查，以确认非典型病例中的小神经纤维或大神经纤维功能障碍。虽然,目前,DPN的一线干预措施主要表现为优化血糖控制(主要针对1型糖尿病)和多因素干预(主要针对2型糖尿病),需要针对DPN的个体化发病机制的治疗方法。α-硫辛酸（ALA）似乎是一种重要的一线致病药物，考虑到它是一种直接和间接的抗氧化剂，其作用策略是直接针对活性氧，间接地有利于内源性抗氧化能力，以改善DPN条件。该领域现有的研究还存在差距,需要精心设计，健壮,具有敏感终点和标准化方案的多中心临床试验，以通过简单有效的算法促进DPN的诊断，并跟踪疾病进展和治疗反应。识别生物标志物/预测因子，从潜在的疾病改变的角度允许个性化的方法可能为在DPN的早期阶段有效的新治疗提供机会。并可能改变疾病的自然进程。这份专家意见文件预计将提高医生对概念的认识，临床,和DPN的治疗方面，并帮助他们及时识别DPN，并将这些信息转化为他们的临床实践，以实现DPN患者管理的最佳实践。
