New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine

Abstract

Diabetic peripheral neuropathy (DPN) is a common chronic complication of diabetes mellitus. It leads to distressing and expensive clinical sequelae such as foot ulceration, leg amputation, and neuropathic pain (painful-DPN). Unfortunately, DPN is often diagnosed late when irreversible nerve injury has occurred and its first presentation may be with a diabetic foot ulcer. Several novel diagnostic techniques are available which may supplement clinical assessment and aid the early detection of DPN. Moreover, treatments for DPN and painful-DPN are limited. Only tight glucose control in type 1 diabetes has robust evidence in reducing the risk of developing DPN. However, neither glucose control nor pathogenetic treatments are effective in painful-DPN and symptomatic treatments are often inadequate. It has recently been hypothesized that using various patient characteristics it may be possible to stratify individuals and assign them targeted therapies to produce better pain relief. We review the diagnostic techniques which may aid the early detection of DPN in the clinical and research environment, and recent advances in precision medicine techniques for the treatment of painful-DPN.

<p>Prevalence and Risk Factors for Diabetic Peripheral Neuropathy Among Saudi Hospitalized Diabetic Patients: A Nested Case-Control Study</p>

“…Other serious complications include: leg ulcers that can eventually end in leg amputation. [1][2][3][4][5]20,21 DPN is classified into numerous types and subtypes based on a mixture of phenomenological, aetiological, pathological and neurophysiological parameters. 1,[22][23][24] In a retrospective study, like the present one, it is difficult to assure the reliability of information on the details of these types or subtypes and be confident that such information has been documented in every patient.…”

“…The close association between DPN and modifiable cardiovascular risk factors (cardiometabolic disease) including elevated triglyceride levels (hyperlipidemia), body mass index (BMI), smoking, hypertension and cardiovascular disease was documented repeatedly in previous studies. 1,20,21,24,42 However, no specific mechanisms linking DPN with cardiovascular disease have been suggested in any of these studies.…”

“…On the other hand, many other studies have reported a significant association between female gender and the prevalence of DPN. 1,20,21,24 In the multivariate model, we identified three risk factors that independently correlate with the presence of DPN. These were age, chronic kidney disease and peripheral vascular disease.…”

The impact on large fibre function and small fibre function in patients with type 2 diabetes on benfotiamine therapy

“…These transporters belong to the family of solute carriers (SLCs) Both these transporters facilitate absorption of thiamine in micromolar to nanomolar range from the intestinal lumen and follow saturation kinetics principles. These transporters are also expressed in other tissues such as pancreas, kidney, and brain [8], which facilitates free thiamine transport into the tissues [9][10][11][12]. The results of the gene expression will be presented in the consequent article.…”

circRNAs Signature as Potential Diagnostic and Prognostic Biomarker for Diabetes Mellitus and Related Cardiovascular Complications

“…It is a life-threatening disorder that involves both peripheral and autonomic nerves, affecting more than 50% of the diabetic population [80]. To date, our understanding of the pathophysiology of DNP remains elusive [81]. The role of epigenetics in this disease has been suggested recently.…”