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New perspectives in diabetic neuropathy.

ABSTRACT: Diabetes prevalence continues to climb with the aging population. Type 2 diabetes (T2D), which constitutes most cases, is metabolically acquired. Diabetic peripheral neuropathy (DPN), the most common microvascular complication, is length-dependent damage to peripheral nerves. DPN pathogenesis is complex, but, at its core, it can be viewed as a state of impaired metabolism and bioenergetics failure operating against the backdrop of long peripheral nerve axons supported by glia. This unique peripheral nerve anatomy and the injury consequent to T2D underpins the distal-to-proximal symptomatology of DPN. Earlier work focused on the impact of hyperglycemia on nerve damage and bioenergetics failure, but recent evidence additionally implicates contributions from obesity and dyslipidemia. This review will cover peripheral nerve anatomy, bioenergetics, and glia-axon interactions, building the framework for understanding how hyperglycemia and dyslipidemia induce bioenergetics failure in DPN. DPN and painful DPN still lack disease-modifying therapies, and research on novel mechanism-based approaches is also covered.

SUBMITTER: Eid SA

PROVIDER: S-EPMC10525009 | biostudies-literature | 2023 Sep

REPOSITORIES: biostudies-literature

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New perspectives in diabetic neuropathy.

Eid Stephanie A SA Rumora Amy E AE Beirowski Bogdan B Bennett David L DL Hur Junguk J Savelieff Masha G MG Feldman Eva L EL

Neuron 20230531 17

Diabetes prevalence continues to climb with the aging population. Type 2 diabetes (T2D), which constitutes most cases, is metabolically acquired. Diabetic peripheral neuropathy (DPN), the most common microvascular complication, is length-dependent damage to peripheral nerves. DPN pathogenesis is complex, but, at its core, it can be viewed as a state of impaired metabolism and bioenergetics failure operating against the backdrop of long peripheral nerve axons supported by glia. This unique periph ...[more]

PMID: 37263266

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Project description:BackgroundLittle information exists on the understanding and management of painful diabetic peripheral neuropathy (pDPN) between patients and healthcare practitioners (HCPs).ObjectiveThe objective of this study was to characterize the patient perspective of pDPN and identify gaps in patient and HCP perceptions of pDPN.MethodsAn online survey of patients with type 1 or 2 diabetes mellitus who reported experiencing any symptoms consistent with diabetic peripheral neuropathy (DPN) and HCPs who treat diabetes was conducted in 2012 in the USA. Patients were recruited via the Survey Sampling national consumer research panel, and HCPs were recruited from Epocrates' national research panel. Survey questions focused on the impact, understanding, and management of pDPN, and interactions between patients and their HCPs. Respondents who reported pain were re-contacted to obtain further information on pain severity using a numerical rating scale (0 = no pain, 10 = most pain).ResultsRespondents included 1,004 patients (53 % female, average age 55 years) and 500 HCPs (250 generalists, 150 specialists, and 100 nurses/physician assistants). While 83 % of patients reported pDPN symptoms, only 41 % of these patients had been diagnosed with DPN. Eighty-five percent of those with pDPN reported that it impacts daily activities. In contrast, HCPs estimated that of their patients who experienced any type of DPN symptom, 41 % experienced pain and 38 % had daily activity limitations because of their symptoms. Most HCPs (64 %) never had their patients complete a DPN assessment questionnaire, and only 41 % perform specific diagnostic tests on all patients who report DPN symptoms. Patients and HCPs both showed substantial clinical misperceptions regarding the cause and management of pDPN; 53 % of HCPs believed that adequate blood glucose control could reverse DPN, and 43 % of pDPN patients were not sure if DPN was reversible. There was also substantial discordance between patients and HCPs regarding discussions of DPN; only 49 % of pDPN patients reported that they speak about symptoms at "every" or "most" appointments with their HCP but 73 % of HCPs reported discussing DPN symptoms at "every" or "most" visits.ConclusionsNot only do misperceptions exist on the cause and management of pDPN among patients and HCPs, but there are additional disparities between the patient and HCP perspectives. These results suggests a need for (1) educational initiatives on pDPN that target patients and HCPs, and (2) initiating improved dialogue between patients and their HCPs for discussing appropriate management of pDPN that is distinct from treatment of the underlying diabetes.

Project description:BackgroundDiabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus and can lead to serious complications. Therapeutic strategies for pain control are available but there are few approaches that influence neurological deficits such as numbness.AimTo investigate the effectiveness of acupuncture on improving neurological deficits in patients suffering from type 2 DPN.MethodsThe acupuncture in DPN (ACUDPN) study was a two-armed, randomized, controlled, parallel group, open, multicenter clinical trial. Patients were randomized in a 1:1 ratio into two groups: The acupuncture group received 12 acupuncture treatments over 8 wk, and the control group was on a waiting list during the first 16 wk, before it received the same treatment as the other group. Both groups received routine care. Outcome parameters were evaluated after 8, 16 and 24 wk and included neurological scores, such as an 11-point numeric rating scale (NRS) 11 for hypesthesia, neuropathic pain symptom inventory (NPSI), neuropathy deficit score (NDS), neuropathy symptom score (NSS); nerve conduction studies (NCS) were assessed with a handheld point-of-care device.ResultsSixty-two participants were included. The NRS for numbness showed a difference of 2.3 (P < 0.001) in favor of the acupuncture group, the effect persisted until week 16 with a difference of 2.2 (P < 0.001) between groups and 1.8 points at week 24 compared to baseline. The NPSI was improved in the acupuncture group by 12.6 points (P < 0.001) at week 8, the NSS score at week 8 with a difference of 1.3 (P < 0.001); the NDS and the TNSc score improved for the acupuncture group in week 8, with a difference of 2.0 points (P < 0.001) compared to the control group. Effects were persistent in week 16 with a difference of 1.8 points (P < 0.05). The NCS showed no meaningful changes. In both groups only minor side effects were reported.ConclusionStudy results suggest that acupuncture may be beneficial in type 2 diabetic DPN and seems to lead to a reduction in neurological deficits. No serious adverse events were recorded and the adherence to treatment was high. Confirmatory randomized sham-controlled clinical studies with adequate patient numbers are needed to confirm the results.

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New perspectives in diabetic neuropathy.

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New perspectives in diabetic neuropathy.

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