ReviewsDiabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy
Introduction
Diabetes has reached epidemic proportions worldwide, with International Diabetes Federation estimates suggesting a prevalence of 425 million people worldwide in 2017, rising to 628 million by 2045.1 This rise will be accompanied by an increase in the prevalence of the complications of diabetes.2 DPN is the most common cause of neuropathy worldwide, and is estimated to affect around half of people with diabetes.3, 4 It causes considerable morbidity, impairs quality of life, and increases mortality.5, 6 Indeed, approximately one fourth of the US health care expenditure on diabetes is spent on DPN.7
Diabetic neuropathy refers to a collection of clinically diverse disorders affecting the nervous system, with differing anatomic features, clinical courses, and phenotypes. The common underlying pathophysiology is a consequence of hyperglycemia and microangiopathy.8 The commonest form is distal symmetric sensorimotor polyneuropathy9; however, most body systems can be affected through involvement of the autonomic nerves. Despite the considerable, health care–related economic burden and effect on quality of life in DPN, treatment options are limited and prevention remains the key goal.10 The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN.
Section snippets
Materials and Methods
A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors' expertise in DPN. Articles published from inception of databases to December 2017 were identified. Data from articles that were felt not relevant by authors with the guidance of the senior reviewers (R.A.M., U.A.) were excluded from the review.
Results
Databases searches were undertaken and 188 papers were cited in the final manuscript. Authors excluded studies that were not considered relevant to the aims of this article. Further appraisal of selected articles were undertaken and any relevant explanatory data from said articles were included in the present review as descriptive prose.
Conclusions
DPN is common, often misdiagnosed, and inadequately treated. DPN accounts for considerable morbidity and mortality and reduced quality of life. Clinical recognition is required for allowing timely symptomatic management to reduce the morbidity associated with this condition. Glycemic control is the central component of treatment, but it is difficult to achieve for many patients. Cardiovascular risk factors play a major role in the pathogenesis of DPN and should be intensively controlled with a
Conflicts of Interest
The authors have indicated that they have no conflicts of interest with regard to the content of this article.
Acknowledgments
No other individuals were involved in the production of this manuscript. There was no financial support for the production of this article. All authors contributed equally to the production of this manuscript.
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