糖尿病周围神经病变的药物治疗近况

糖尿病周围神经病变是糖尿病最常见并发症之一,其发生率可高达25％～90％,神经病变可累及感觉神经、运动神经及植物神经,产生疼痛、麻木、运动障碍及自主神经功能障碍。近年来,随着糖尿病及其并发症基础研究的进展,如神经血流量测定、神经病变超微结构和酶动力学研究,不仅对糖尿病周围神经病变的发病机制加深了认识,同时为针对性药物治疗措施提供了理论基础。由于高血糖与糖尿病神经病变有关,因而良好地控制血糖是预防糖尿病周围神经病变的基本措施。恰当地对症治疗有利于受损神经的修复。近年来,发现有多种药物治疗糖尿病周围神经病变取得较好的效果,现予综述如下:     

黛力新联合加巴喷丁治疗老年痛性糖尿病周围神经病变的疗效

目的观察黛力新联合加巴喷丁治疗老年痛性糖尿病周围神经病变(PDPN)的临床疗效及安全性。方法 90例PDPN患者,男47例,女43例,随机分为对照组、加巴喷丁组、黛力新和加巴喷丁联合组,每组30例。治疗4 w后观察各组疗效、神经传导速度及不良反应。结果和治疗前比较,治疗后各组疼痛程度均下降,而黛力新联合加巴喷丁组视觉模拟评分法(VAS)评分下降优于加巴喷丁组及对照组(均P<0.05)。和治疗前比较,治疗后各组神经传导速度均增加(P<0.05)。三组均未观察到需要临床干预或中止治疗的不良反应。结论黛力新联合加巴喷丁可有效缓解老年患者PDPN,联合治疗疗效优于单药,同时具有一定的安全性。     

依帕司他治疗糖尿病周围神经病变60例临床分析

糖尿病周围神经病变(DPN)是一种持续高糖引起的退行性神经病变.其中,轴突萎缩、髓鞘脱失在临床上能够采用神经传导速度进行评估.在高糖环境中,未成熟的退行性神经元的异常激动导致自发性疼痛、麻木和感觉异常,这些典型临床表现极大地损害绝大多数病人的生活质量.糖尿病神经病变的进展可能导致足部溃疡、截肢.醛糖还原酶抑制剂( ARI)目前作为一种糖尿病神经病变治疗手段受到了极大关注,并且发展出了许多药物[1].本研究通过观察电生理学指标以及症状疗效,与甲钴胺治疗做比较,研究依帕司他(唐林)治疗DPN的疗效.     

糖尿病周围神经病变的发病机制及治疗进展

糖尿病周围神经病变是糖尿病最常见并发症之一,其发生率可高达25%～90%,糖尿病神经病变是指高血糖为特征的机体代谢障碍而累及神经系统的疾病,是糖尿病最常见的慢性并发症之一。糖尿病神经病变主要包括周围神经病变、植物神经病变、颅神经病变、脊髓病变、脑部病变及糖尿病肌营养不良(肌肉萎缩)等疾病,其中又以前两者为多见。临床上对此尚缺乏特异性治疗方法。近年来,随着糖尿病及其并发症基础研究的进展,如神经血流量测定、神经病变超微结构和酶动力学研究,不仅对糖尿病周围神经病变的发病机制加深了认识,同时为针对性药物治疗措     

糖尿病痛性神经病变药物治疗的评价

WHO估计目前世界上有糖尿病患者超过1.5亿,到2025年将达到3亿人。约50%的糖尿病患者伴有糖尿病神经病变[1]。严重者发生足部溃疡或截肢。目前还没有一种基于神经损伤和修复机制的药物被批准用于临床治疗。本文介绍糖尿病痛性神经病变治疗方面的一些进展。糖尿病痛性神经病变机制糖尿病神经病变引起的疼痛主要发生在下肢。疼痛方式多种多样,有轻度的麻木感,深部刺痛和持续性疼痛不适等。疼痛的频率及强度也有波动性变化。夜间疼痛往往加剧,患者出现睡眠剥夺和抑郁状态。神经性疼痛,无论是周围神经性还是中枢神经性,其特点均是由于损伤部位…     

痛性糖尿病周围神经病变患者血清Metrnl水平变化的研究

目的 探讨痛性糖尿病周围神经病变(PDPN)患者血清Metrnl水平的变化。方法 选取2020年10月至2021年9月于山东第一医科大学附属莱钢医院内分泌科住院治疗的T2DM患者180例，分为单纯糖尿病组(n=54)、非PDPN组(non-PDPN,n=56)及PDPN组(n=70)。PDPN组根据视觉模拟评分法(VAS)分为轻度疼痛亚组22例、中度疼痛亚组25例及重度疼痛亚组23例。同期选取我院体检健康者50名为正常对照(NC)组。比较各组及各亚组一般资料及血清Metrnl水平。结果 NC、T2DM、non-PDPN、PDPN组血清Metrnl依次降低(P<0.05)。PDPN各亚组中，VAS评分越高，血清Metrnl越低(P<0.05)。Spearman相关分析显示，血清Metrnl与胫神经运动神经传导速度、腓总神经感觉神经传导速度及超氧化物歧化酶(SOD)呈正相关(P<0.05)，与DM病程、TG、胰岛素抵抗指数、HbA₁c、VPT、TNF-α、IL-6、丙二醛及VAS评分呈负相关(P<0.05)。Logistic回归分析显示，校正D...     

欧迪美~治疗2型糖尿病性周围神经病变50例疗效观察

本文观察50例2型糖尿病患者,探讨欧迪美对2型糖尿病性周围神经病变患者疼痛缓解程度及神经传导速度的影响。结果:观察组前后正中神经、腓神经的运动神经传导速度(MNCV)、感觉神经传导速度(SNCV)均明显改善,治疗组疼痛缓解率及神经传导速度均高于对照组(P<0.05)。结论:欧迪美能改善2型糖尿病性周围神经的MNCV、SNCV,从而对2型糖尿病性周围神经病变方面有较好的治疗作用。     

维生素B6与糖尿病周围神经病变关系的研究进展

糖尿病神经病变是糖尿病最常见的慢性并发症之一,病变可累及中枢神经和周围神经,后者尤为常见,通常为对称性,下肢较上肢严重,病情进展缓慢,严重时影响患者的生活质量.有关糖尿病周围神经病变的发病机制,目前尚不十分清楚.因此,迄今临床上尚无安全可靠的治疗方法.维生素类是糖尿病周围神经病变最基本、最早应用的药物.本文就维生素B6在糖尿病周围神经病变发病中的作用及补充维生素B6的疗法综述如下.     

糖尿病周围神经病变中医药治疗进展

糖尿病周围神经病变(diabetic peripheral neuropathy,DPN)是糖尿病常见的并发症之一,可导致肢体的疼痛、麻木、感觉异常,甚至肌肉萎缩等,严重影响患者的生存和生活质量,是糖尿病致残的重要原因之一[1].目前,现代医学治疗DPN尚缺乏特异治疗措施,多采用营养神经、改善微循环、醛糖还原酶抑制剂及对症治疗.中医药治疗DPN,取得了一定进展.     

胰岛素泵联合甲钴胺治疗糖尿病周围神经病变的疗效观察

目的分析胰岛素泵联合甲钴胺治疗糖尿病周围神经病变的临床效果。方法采用双机随照的设计方法 ,将该院收治的60例糖尿病周围神经病变患者分成两组,对照组给予胰岛素泵强化治疗,试验组在对照组基础上静脉注射甲钴胺,比较两组治疗前后神经症状、麻木及疼痛评分,并评价临床疗效。结果两组治疗后神经症状TCSS、疼痛及麻木VAS评分均较治疗前下降(P0.05),不过试验组改善效果优于对照组(P0.05)。试验组治疗总有效率90.0%,要明显高于对照组的80.0%(P0.05)。结论胰岛素泵强化联合甲钴胺静脉给药,能显著改善糖尿病周围神经病变患者症状,效果值得肯定。     

Sleep impairment: Is it an overlooked burden in painful diabetic peripheral neuropathy? A single-centre,cross-sectional study from south India

Background and aimsPainful diabetic peripheral neuropathy (PDPN) is a common complication of type 2 diabetes. The unrelenting pain associated with PDPN adversely affects a patient's quality of life. Recognizing the crucial role that sleep plays in the metabolic control of diabetes, this study aims to estimate the prevalence of sleep impairment in painful diabetic peripheral neuropathy (PDPN) and identify the factors associated with it.MethodsWe conducted a cross-sectional study among 156 patients in a tertiary care hospital in south India. We recruited consenting adults with PDPN. Sleep quality was analyzed using the Pittsburg sleep quality index (PSQI), a self-rating scale. Hba1c served as a measure of glycemic control. Anxiety and depression were assessed using the hospital anxiety and depression (HAD) scale. Data were analyzed in SPSS 26.0.ResultsA total of 156 patients were included in the study with a mean age of 58.39 ± 9.12 years. In 151 (96.79%) patients demonstrated sleep impairment with a global PSQI score of 10.92 ± 2.87. Female sex, ischemic heart disease (IHD), high anxiety levels and use of insulin, pregabapentin, and duloxetine; were significantly associated with poor sleep quality (p < 0.05). The median Hba1c was high (9% [7.46–11.1]). However, there was no statistical correlation between the degree of sleep impairment and glycemic control.ConclusionWe found a high prevalence of sleep impairment in patients with PDPN. Female sex, IHD, high anxiety levels and use of neuropathic drugs were predictors of poor sleep quality.     

Prevalence and clinical implications of painful diabetic peripheral neuropathy in type 2 diabetes: Results from a nationwide hospital-based study of diabetic neuropathy in Korea

Aims

To determine the prevalence and risk factors for painful diabetic peripheral neuropathy (PDPN) and evaluate sleep impairment and quality of life in patients with PDPN.

Methods

Data from the Korean Diabetes Association Neuropathy Study Group were used to evaluate 3999 patients with type 2 diabetes. PDPN was diagnosed using visual analogue scales (VAS) and medical history. The patients were asked to answer the Brief Pain Inventory-Short Form (BPI-SF), Medical Outcomes Study Sleep (MOS-Sleep) Scale, EuroQol (EQ-5D), and VAS.

Results

Among the patients with diabetic peripheral neuropathy (n = 1338), 577 (43.1%) were diagnosed with PDPN (14.4% of all patients with type 2 diabetes). PDPN was independently associated with age, female gender, fasting plasma glucose, hypertension, and previous cerebrovascular events. All pain severity and interference measures were higher in patients with PDPN than in non-PDPN patients, and patients with PDPN reported more impaired sleep and lower EQ-5D and VAS scores.

Conclusions

The prevalence of PDPN in Koreans was comparable to that in Western populations. PDPN may impair sleep and quality of life compared with non-PDPN, and physicians should carefully consider pain symptoms in patients with diabetic peripheral neuropathy.     

Efficacy and safety of Mudan granules for painful diabetic peripheral neuropathy: A protocol for a double-blind randomized controlled trial

Background:As one of the most challenging complications in the management of diabetes mellitus, painful diabetic peripheral neuropathy (PDPN) is accompanied by various clinical manifestations, including numbness, burning, coldness, and other sensory abnormalities in the extremities. Meanwhile, PDPN seriously affects the life quality of patients and causes great pain. Western medicine mostly provides symptomatic treatments, such as antioxidants, aldose reductase inhibitors, nerve nutrition, microcirculation improvement, and analgesic drugs on the basis of blood sugar control. Although certain efficacy has been achieved, the problem has not been solved at root. Mudan granules have some advantages in the treatment of PDPN, but there is insufficient high-quality clinical studies to verify this. Therefore, the purpose of this study was to evaluate the efficacy and safety of Mudan granules in treating PDPN.Methods:A randomized, double-blind, placebo, and parallel-controlled trial design was used to study the efficacy and safety of Mudan granules in the treatment of PDPN. In this study, 93 patients with painful diabetic neuropathy were recruited and randomly divided into a treatment group and a placebo group based on 1:1. The treatment group was given Mudan granules and the control group accepted placebo treatment, and the basic treatment was performed according to the recommended guidelines. During the treatment period, the patients’ visual analog scores, clinical efficacy, Medical Outcomes Study 36-item Short-Form Health Survey (SF-36) scores, nerve conduction velocity, and drug-induced adverse reactions were observed at baseline after 8 and 10 weeks.Discussion:This study will evaluate the efficacy and safety of Mudan granules in treating PDPN. The experimental results will provide evidence support to treat PDPN with Mudan granules.Trial registration:DOI 10.17605/OSF.IO/5CE32.     

Variability of fasting plasma glucose and the risk of painful diabetic peripheral neuropathy in patients with type 2 diabetes

Aim

The relationship between glycaemic variability and painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes (T2D) is unclear. The aim of this study was to investigate whether variations in fasting plasma glucose (FPG), as represented by the coefficient of variation (CV), were associated with the risk of PDPN in patients with T2D.

加巴喷丁治疗糖尿病性神经痛的研究进展

糖尿病性神经痛是神经病理性疼痛的一个主要类型,患病人数多,治疗困难.加巴喷丁是一种新型的抗癫痫药物,目前被广泛应用十治疗糖尿病性神经痛,其镇痛机制尚未完全明确,对电压门控钙通道α2δ-1亚单位的调节作用可能是其主要作用机制.加巴喷丁治疗糖尿病神经性疼痛效果明确,不良反应轻微,是治疗糖尿病性神经痛较为理想的药物.     

Painful and Painless Diabetic Neuropathy: One Disease or Two?

Painful diabetic polyneuropathy (PDPN) is generally considered a variant of diabetic polyneuropathy (DPN) but the identification of distinctive aspects that characterize painful compared with painless DPN has however been addressed in many studies, mainly with the purpose of better understanding the mechanisms of neuropathic pain in the scenario of peripheral nerve damage of DPN, of determining risk markers for pain development, and also of recognizing who might respond to treatments. This review is aimed at examining available literature dealing with the issue of similarities and differences between painful and painless DPN in an attempt to respond to the question of whether painful and painless DPN are the same disease or not and to address the conundrum of why some people develop the insensate variety of DPN whilst others experience distressing pain. Thus, from the perspective of comparing painful with painless forms of DPN, this review considers the clinical correlates of PDPN, its distinctive framework of symptoms, signs, and nerve functional and structural abnormalities, the question of large and small fiber involvement, the peripheral pain mechanisms, the central processing of pain and some new insights into the pathogenesis of pain in peripheral polyneuropathies and PDPN.     

糖尿病痛性周围神经病的临床及电生理特点分析

目的探讨糖尿病痛性周围神经病（PDPN）的临床和电生理特点。方法严格入选32例PDPN患者,病程〉1年,疼痛视觉模拟评分〉4,未伴有其他内科系统合并症,进行视觉模拟评分（VAS）并记录疼痛性质。电生理检测包括：常规神经传导速度（NCV）、定量感觉检测（温度觉）（QST-t）。结果PDPN往往有客观的感觉异常,但神经系统体征不典型,NCV检测可正常,而QST—t可有异常表现,本组NCV检测13例正常,其中11例QST-t异常;本组NCV异常率为59．4％,QST异常率为87．5％,QST＋NCV异常率为93．7％。VAS与QST的上下肢热痛觉（HP）呈正相关（t=0．595、P=0．009;t=0．784、P=0．004）,与胫神经的感觉神经传导速度（SCV）呈负相关（t=-0．554;P=0．032）;与其它电生理各项参数不相关,与空腹血糖、糖化血红蛋白、病程及疼痛病程不相关。结论PDPN以小纤维受累为主,QST可为早期PDPN提供客观的临床依据;疼痛程度与C类纤维及下肢胫神经感觉纤维病变有一定的相关性。     

Treatment of symptomatic diabetic neuropathy

Painful diabetic neuropathy is a common and particularly unpleasant long-term complication of diabetes that affects a significant minority of patients with distal polyneuropathy. After exclusion of other causes of neuropathic pain, attention should be focused on achieving optimal and stable glycaemic control avoiding flux of blood glucose levels, which have been shown to aggravate pain. Most patients will require pain control therapy and whilst the tricyclic drugs remain a first-line approach, their use is often hampered by predictable but troublesome side effects. Gabapentin, the only agent specifically licensed for the treatment of neuropathic pain in the United Kingdom, is useful in diabetic neuropathy and is generally better tolerated than the tricyclics. Additionally, other pharmacological and non-pharmacological pain management approaches may be useful. Patient education has a significant role to play in the avoidance of late neurological complications.     

Pentoxifylline in the treatment of distal diabetic neuropathy

Painful diabetic distal sensory neuropathy is a disabling and common complication of diabetes mellitus. There is evidence that microvascular changes resulting in ischemia to the vasa nervorum may contribute to this problem. Pentoxifylline has been shown to improve circulation through partially occluded peripheral vessels and has been postulated to be of potential benefit. Forty adult type II diabetics were enrolled in a double-blind, placebo-controlled study utilizing pentoxifylline for six months. Visual analog scores, nerve conduction studies, and physical examinations were used to evaluate response to treatment. At the end of the six-month trial, there was no significant difference in the patients' pain between the pentoxifylline- and placebo-treated groups. The authors conclude that pentoxifylline is not useful in the treatment of painful distal diabetic neuropathy.     

New treatments for diabetic neuropathy: Symptomatic treatments

Painful diabetic neuropathy is a common distressing and challenging condition. The mechanism or mechanisms involved in its pathogenesis continue to elude clinical scientists. As with other conditions of painful distal symmetrical neuropathic conditions, pain relief involves the use of a variety of analgesic and neuroleptic drugs, aimed at reducing either central responses to painful stimuli or at dampening spontaneous irritability of affected neurons. More recently, several therapies directed at putative pathologic mechanisms specific to painful diabetic neuropathy have evolved. These include vasodilators, protein kinase C β inhibition, antioxidants, and novel aldose reductase inhibitors. Preliminary clinical studies of these therapies have at present involved small numbers of patients; however, the results have been encouraging. This article considers the clinical aspects of diagnosis and management of chronic painful diabetic neuropathy, focusing on existing and newer therapies.