Updates in diabetic neuropathy: A call for new diagnostic and treatment approaches

Advantages of omics approaches for elucidating metabolic changes in diabetic peripheral neuropathy

Various animal and cell culture models of diabetes mellitus (DM) have been established and utilized to study diabetic peripheral neuropathy (DPN). The divergence of metabolic abnormalities among these models makes their etiology complicated despite some similarities regarding the pathological and neurological features of DPN. Thus, this study aimed to review the omics approaches toward DPN, especially on the metabolic states in diabetic rats and mice induced by chemicals (streptozotocin and alloxan) as type 1 DM models and by genetic mutations (MKR, db/db and ob/ob) and high-fat diet as type 2 DM models. Omics approaches revealed that the pathways associated with lipid metabolism and inflammation in dorsal root ganglia and sciatic nerves were enriched and controlled in the levels of gene expression among these animal models. Additionally, these pathways were conserved in human DPN, indicating the pivotal pathogeneses of DPN. Omics approaches are beneficial tools to better understand the association of metabolic changes with morphological and functional abnormalities in DPN.

The Effect of Exercise on Cardiovascular Autonomic Nervous Function in Patients with Diabetes: A Systematic Review

BACKGROUND

Diabetic neuropathy, including autonomic neuropathy, is a severe complication in patients with poorly controlled diabetes. Specifically, cardiovascular autonomic neuropathy (CAN) plays a significant prognostic role in cardiovascular morbidity and mortality. Exercise, an essential component of diabetes treatment, may have a therapeutic effect on patients with diabetes complicated by CAN. However, it remains unclear whether exercise has a therapeutic or protective effect in diabetes patients with CAN.

METHODS

The author conducted a systematic search of PubMed/MEDLINE, Embase, and The Cochrane Library, resulting in the identification of eight eligible randomized controlled trials for this review.

RESULTS

Exercise, including aerobic exercise combined with resistance training (RT), high-intensity interval training, and progressive RT, has shown a beneficial effect on cardiac autonomic function (CAF) in patients with type 2 diabetes, as measured by heart rate variability, heart rate recovery, and baroreflex sensitivity. However, most studies had low quality. Moreover, there were no relevant studies examining the effect of exercise on CAF in older patients, patients with poorly controlled diabetes, and patients with type 1 diabetes.

CONCLUSIONS

Exercise has the potential to manage patients with CAN by balancing sympathetic and parasympathetic nervous system functions; however, further studies are warranted in the future.

Screening for diabetic peripheral neuropathy in resource-limited settings

BACKGROUND

Diabetic neuropathy is the most common microvascular complication of diabetes mellitus and a major risk factor for diabetes-related lower-extremity complications. Diffuse neuropathy is the most frequently encountered pattern of neurological dysfunction and presents clinically as distal symmetrical sensorimotor polyneuropathy. Due to the increasing public health significance of diabetes mellitus and its complications, screening for diabetic peripheral neuropathy is essential. Consequently, a review of the principles that guide screening practices, especially in resource-limited clinical settings, is urgently needed.

MAIN BODY

Numerous evidence-based assessments are used to detect diabetic peripheral neuropathy. In accordance with current guideline recommendations from the American Diabetes Association, International Diabetes Federation, International Working Group on the Diabetic Foot, and National Institute for Health and Care Excellence, a screening algorithm for diabetic peripheral neuropathy based on multiphasic clinical assessment, stratification according to risk of developing diabetic foot syndrome, individualized treatment, and scheduled follow-up is suggested for use in resource-limited settings.

CONCLUSIONS

Screening for diabetic peripheral neuropathy in resource-limited settings requires a practical and comprehensive approach in order to promptly identify affected individuals. The principles of screening for diabetic peripheral neuropathy are: multiphasic approach, risk stratification, individualized treatment, and scheduled follow-up. Regular screening for diabetes-related foot disease using simple clinical assessments may improve patient outcomes.