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Current Diabetes Reviews

Editor-in-Chief

ISSN (Print): 1573-3998
ISSN (Online): 1875-6417

Review Article

Review of Diabetic Polyneuropathy: Pathogenesis, Diagnosis and Management According to the Consensus of Egyptian Experts

Author(s): Fahmy Amara*, Sherif Hafez, Abbas Orabi, Adel El Etriby, Aly Ahmed Abdel Rahim, Ebtissam Zakaria, Farouk Koura, Farouk Mohamed Talaat, Hanan Gawish, Ihab Attia, Mohamed Fahmy Abdel Aziz, Mohamed Hesham Mohamed Fahmy El Hefnawy, Mohamed Kamar, Mohamed Reda Halawa, Mohamed Shawky El-Sayed, Nabil Abdelfatah El Kafrawy, Samir Helmy Assaad Khalil and Samir Naem Assaad

Volume 15, Issue 4, 2019

Page: [340 - 345] Pages: 6

DOI: 10.2174/1573399815666190226150402

open access plus

Abstract

Diabetic polyneuropathy (DPN) is a complex and multifactorial entity in which various factors besides hyperglycemia play an important role. Symptoms of DPN are sensory, motor or autonomic. Intensive research proved that oxidative stress is the common denominator for the four major destructive pathways of hyperglycemia including increased hexosamine pathway flux, activation of Protein kinase-C (PKC) pathway, increased Advanced Glycated End-products (AGEs) formation, and increased Polyol Pathway flux. National data in Egypt confirms that more than 60% of Egyptian diabetic patients suffer from neuropathy. The most common complications of DPN are Cardiac Autonomic Neuropathy (CAN), diabetic foot and ulcers, neuromuscular disability, and anxiety. In addition, DPN affects the Quality of Life (QoL). According to common clinical practice, the common diagnostic tools are bed-side diagnosis and electrophysiological tests. Early diagnosis is critical to improve the prognosis of DPN and therapeutic intervention in the early phase. In this review, we provide a clear understanding of the pathogenesis, early diagnosis and the good management of DPN. Since the pathogenesis of DPN is multifactorial, its management is based on combination therapy of symptomatic; either pharmacological or non-pharmacological treatments, and pathogenic treatment. Alpha Lipoic Acid (ALA) is a potent anti-oxidant that has several advantages as a pathogenic treatment of DPN. So, in clinical practice, ALA may be prescribed for patients with early neuropathic deficits and symptoms. Patient education has an important role in the managemement of DPN.

Keywords: Diabetic polyneuropathy, pathogenesis, prevalence, diagnosis, management, protein kinase-C.

[1]
Perez-Matos M, Morales-Alvarez M, Mendivil C. Lipids: A suitable therapeutic target in diabetic neuropathy? J Diabetes Res 2017; 2017: 6943851.
[2]
Nukada H. Ischemia and diabetic neuropathy. Diabetes and the Nervous System. 3rd ed. Elsevier Science . 2014; 126: pp. 469-87.
[3]
Allen M, Doherty T, Rice C, Kimpinski K. Physiology in Medicine: neuromuscular consequences of diabetic neuropathy. J Appl Physiol 2016; 121(1): 1-6.
[4]
Sun M, Zhang M, Shen J, Yan J, Zhou B. Critical appraisal of international guidelines for the management of diabetic neuropathy: is there global agreement in the internet era? Int J Endocrinol 2015; 1-11.
[5]
Sung J-Y, Tani J, Chang T-S, Lin CS-Y. Uncovering sensory ax-onal dysfunction in asymptomatic type 2 diabetic neuropathy. PLoS One 2017; 12(2): e0171223.
[6]
Greig M, Tesfaye S, Selvarajah D, Wilkinson I. Insights into the pathogenesis and treatment of painful diabetic neuropathy. Diabetes and the nervous system. 3rd ed. Elsevier Science. 2014; 126: pp. (3)559-78.
[7]
Peltier A, Goutman SA, Callaghan BC. Painful diabetic neuropa-thy. BMJ 2014; 348: g1799.
[8]
Papanas N, Ziegler D. Risk factors and comorbidities in diabetic neuropathy: an update 2015. Rev Diabet Stud 2015; 12(1-2): 48-62.
[9]
Shakeel M. Recent advances in understanding the role of oxidative stress in diabetic neuropathy. Diabetes Metab Syndr 2015; 9(4): 373-8.
[10]
Sandireddy R, Yerra V, Areti A, Komirishetty P, Kumar A. Neuroinflammation and oxidative stress in diabetic neuropathy: futuristic strategies based on these targets. Int J Endocrinol 2014; 1-10.
[11]
Chilelli N, Burlina S, Lapolla A. AGEs, rather than hyperglycemia, are responsible for microvascular complications in diabetes: A “glycoxidation-centric” point of view. Nutr Metab Cardiovasc Dis 2013; 23(10): 913-9.
[12]
Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev 2012; 28: 8-14.
[13]
Abbott C, Malik R, van Ross E, Kulkarni J, Boulton A. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care 2011; 34(10): 2220-4.
[14]
Assaad-Khalil S, Zaki A, Rehim A, et al. Prevalence of diabetic foot disorders and related risk factors among Egyptian subjects with diabetes. Prim Care Diabetes 2015; 9(4): 297-303.
[15]
Geelen C, Smeets R, Schmitz S, van den Bergh J, Goossens M, Verbunt J. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. Eur J Pain 2017; 21(10): 1632-41.
[16]
Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep 2014; 14(9): 528.
[17]
Tesfaye S, Boulton A, Dyck P, et al. Diabetic neuropathies: up-date on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care 2010; 33(10): 2285-93.
[18]
BOULTON A. Diabetic neuropathy and foot complications. Diabetes and the Nervous System. 3rd ed. Elsevier Science 2014; 126: 97-107.
[19]
Todorovic SM. Treating painful diabetic neuropathy: Preventing pain vs. blocking pain by targeting nociceptive ion channels in sensory neurons. Int Rev Neurobiol 2016; 127: 211-25.
[20]
Raputova J, Srotova I, Vlckova E, et al. Sensory phenotype and risk factors for painful diabetic neuropathy. Pain 2017; 158(12): 2340-53.
[21]
Goel A, Shivaprasad C, Kolly A, Sarathi HAV, Atluri S. Comparison of electrochemical skin conductance and vibration perception threshold measurement in the detection of early diabetic neuropathy. PLoS One 2017; 12(9): e0183973.
[22]
Bril V, England J, Franklin GM, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy. Am Acad Neurol 2011; 76: 1758-65.
[23]
Garcia-Alcala H, Santos VC, Islas MS, et al. Treatment withα-Lipoic acid over 16 weeks in type 2 diabetic patients with symptomatic polyneuropathy who responded to initial 4-week high-dose loading. J Diabetes Res 2015; 2015: 1-8.
[24]
Ziegler D, Schneider E, Boess F, Berggren L, Birklein F. Impact of comorbidities on pharmacotherapy of painful diabetic neuropathy in clinical practice. J Diabetes Complications 2014; 28(5): 698-704.
[25]
Dy SM, Bennett WL, Sharma R, et al. AHRQ comparative effectiveness reviews In: Preventing complications and treating symptoms of diabetic peripheral neuropathy Rockville. Agency for Healthcare Research and Quality (US) 2017.
[26]
Finnerup N, Attal N, Haroutounian S. Pharmacotherapy for neuro-pathic pain in adults: a systematic review and meta-analysis. J Vasc Surg 2015; 62(4): 1091.
[27]
Yasuda H. Pharmacological interventions for painful diabetic neuropathy: Comparative analysis using network meta-analysis. J Diabetes Investig 2015; 6(6): 620-2.
[28]
Oyenihi A, Ayeleso A, Mukwevho E, Masola B. Antioxidant strategies in the management of diabetic neuropathy. BioMed Res Int 2015; 2015: 1-15.
[29]
Calabek B, Callaghan B, Feldman E. Therapy for diabetic neuropa-thy: an overview Diabetes and the Nervous System. 3rd ed. Elsevier Science . 2014; 126: 317-3.
[30]
Van Dam P. Oxidative stress and diabetic neuropathy: pathophysi-ological mechanisms and treatment perspectives. J Peripher Nerv Syst 2002; 7(4): 246-8.
[31]
Papanas N, Ziegler D. Efficacy of α- lipoic acid in diabetic neuropathy. Expert Opin Pharmacother 2014; 15(18): 2721-31.
[32]
Vallianou N, Evangelopoulos A, Koutalas P. Alpha-lipoic acid and diabetic neuropathy. Rev Diabet Stud 2009; 6(4): 230-6.

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