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Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment
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Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment

A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (14 October 2022) | Viewed by 24144

Special Issue Editors

Dr. Joanna Kosacka

E-Mail Website
Guest Editor
Clinic for Endocrinology and Nephrology, Research Laboratory, Universität Leipzig, Liebigstr. 21, 04103 Leipzig, Germany
Interests: endocrinology; neurobiology; obesity; diabetes; iron; adipose tissue
Dr. Marcin Nowicki

E-Mail Website
Guest Editor
Institute of Anatomy, University of Leipzig, Liebigstraße 13, D-04103 Leipzig, Germany
Interests: neurobiology; peripheral neuropathy; obesity; diabetes; inflammation
Dr. Petra Baum

E-Mail Website
Guest Editor
Department of Neurology, University of Leipzig, Liebigstraße 20, D-04103 Leipzig, Germany
Interests: neurobiology; peripheral neuropathy; obesity; diabetes; inflammation

Special Issue Information

Dear Colleagues,

Peripheral diabetic neuropathy (PDN) is a common complication of diabetes mellitus, which leads to structural and functional changes of peripheral nerve fibers. PDN has been recognized as a progressive disease which causes sensitive, motor, or autonomic functional changes to nearly 60 percent of patients with diabetes. However, while clinical examination may identify early signs of neuropathy without symptoms, to date, there is no causal therapy for PDN. The approach is therefore preventive or symptomatic, such as a drug treatment of hyperglycemia and neurological symptoms. Various pathogenic pathways involved in peripheral nerves degeneration have been proposed: i) myoinositol mechanism: hyperglycemia-induced sorbitol accumulation in nerve cells and intracellular myoinositol decrease, ii) oxidative stress, iii) non-enzymatic glycosylation (advances glycosylated end-products—AGE), iv) changes in metal metabolism, v) vascular processes, and vi) neurotrophic deficiency. Very recently, neuroinflammation has been discussed as a facet of PDN. The development of novel therapeutic strategies is warranted to better understand PDN patomechanisms.

The present issue deals with new treatment options for damaged peripheral nerves in pre-diabetic and diabetic patients and in animal models of obesity and diabetes. Moreover, the inflammatory mechanism means that a re-examination of human and experimental PDN is warranted.

Dr. Joanna Kosacka
Dr. Marcin Nowicki
Dr. Petra Baum
Guest Editors

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Keywords

  • peripheral diabetic neuropathy (PDN)
  • pathogenetic factors
  • therapeutic approaches
  • oxidative stress
  • obesity
  • inflammation

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Published Papers (5 papers)

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Research

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12 pages, 1396 KiB  
Article
The Outcome of Surgical Treatment for the Neuropathic Diabetic Foot Lesions—A Single-Center Study
by Florin Bobirca, Catalin Gabriel Smarandache, Anca Bobirca, Cristina Alexandru, Dan Dumitrescu, Anca Pantea Stoian, Cristina Bica, Lacramioara Aurelia Brinduse, Anca Musetescu, Daniela-Elena Gheoca-Mutu, Sebastian Isac and Ioan Ancuta
Life 2022, 12(8), 1156; https://doi.org/10.3390/life12081156 - 29 Jul 2022
Cited by 3 | Viewed by 2871
Abstract
The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary [...] Read more.
The prevalence of diabetic foot complications is continuously increasing as diabetes has become one of the most important “epidemics” of our time. The main objective of this study was to describe the appropriate surgical intervention for the complicated neuropathic diabetic foot; the secondary goal was to find the risk factors associated with minor/major amputation and good or adverse surgical outcomes. This is an observational, retrospective study conducted between 1 January 2018 and 31 December 2019, which included 251 patients from the General Surgery Department at the Dr I. Cantacuzino Clinical Hospital in Bucharest with type II diabetes mellitus and neuropathic diabetic foot complications. The surgical conditions identified at admission were the following: osteitis (38.6%), infected foot ulcer (27.5%), gangrene (20.7%), infected Charcot foot (3.6%), non-healing wound (3.6%), necrosis (3.2%), and granulated wound (2.8%). We found that a minor surgical procedure (transmetatarsal amputation of the toe and debridement) was performed in 85.8% of cases, and only 14.2% needed major amputations. Osteitis was mainly associated with minor surgery (p = 0.001), while the gangrene and the infected Charcot foot were predictable for major amputation, with OR = 2.230, 95% CI (1.024–4.857) and OR = 5.316, 95% CI (1.354–20.877), respectively. Admission anemia and diabetic nephropathy were predictive of a major therapeutical approach, with p = 0.011, OR = 2.975, 95% CI (1.244–8.116) and p = 0.001, OR = 3.565, 95% CI (1.623–7.832), respectively. All the major amputations had a good outcome, while only several minor surgeries were interpreted as the adverse outcome (n = 24). Osteitis (45.8%) and admission anemia (79.2%) were more frequently associated with adverse outcomes, with p = 0.447 and p = 0.054, respectively. The complicated neuropathic diabetic foot requires a surgical procedure mainly associated with a good outcome. Full article
(This article belongs to the Special Issue Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment)
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Review

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16 pages, 5763 KiB  
Review
Novel Biomarkers Predictive of Diabetic Charcot Foot—An Overview of the Literature
by Anca Bobircă, Anca Emanuela Musetescu, Anca Bordianu, Anca Pantea Stoian, Teodor Salmen, Dan-Cristian Marinescu, Cristina Alexandru, Alesandra Florescu, Raluca Radu, Sebastian Isac, Traian Patrascu, Dragos Serban and Florin Bobircă
Life 2022, 12(11), 1944; https://doi.org/10.3390/life12111944 - 21 Nov 2022
Cited by 3 | Viewed by 2997
Abstract
Background: Although Charcot diabetic foot (CDF) is a frequent complication of diabetic neuropathy, less is known about the possibility of its early prevention. Methods: A review of the original articles published in English, using the “biomarkers AND Charcot’s foot” criterion, resulted [...] Read more.
Background: Although Charcot diabetic foot (CDF) is a frequent complication of diabetic neuropathy, less is known about the possibility of its early prevention. Methods: A review of the original articles published in English, using the “biomarkers AND Charcot’s foot” criterion, resulted in 33 articles from the PubMed database and seven articles from the Web of Science database. The five duplicates were eliminated, and two independent reviewers selected the most relevant articles, leaving a total of 21 articles. Results: The biomarkers identified are exhaustively described, related to the system of advanced glycation end products (AGEs) and their soluble receptors (sRAGE), inflammatory cascade, osteoclastogenesis, and, respectively, osteoblastic activity. Conclusions: This article highlights the importance of potential early identifiable biomarkers that can lead to microstructural changes in the affected bones. Full article
(This article belongs to the Special Issue Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment)
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28 pages, 784 KiB  
Review
Prevention and Management Strategies for Diabetic Neuropathy
by Sasha Smith, Pasha Normahani, Tristan Lane, David Hohenschurz-Schmidt, Nick Oliver and Alun Huw Davies
Life 2022, 12(8), 1185; https://doi.org/10.3390/life12081185 - 3 Aug 2022
Cited by 23 | Viewed by 9598
Abstract
Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus [...] Read more.
Diabetic neuropathy (DN) is a common complication of diabetes that is becoming an increasing concern as the prevalence of diabetes rapidly rises. There are several types of DN, but the most prevalent and studied type is distal symmetrical polyneuropathy, which is the focus of this review and is simply referred to as DN. It can lead to a wide range of sensorimotor and psychosocial symptoms and is a major risk factor for diabetic foot ulceration and Charcot neuropathic osteoarthropathy, which are associated with high rates of lower limb amputation and mortality. The prevention and management of DN are thus critical, and clinical guidelines recommend several strategies for these based on the best available evidence. This article aims to provide a narrative review of DN prevention and management strategies by discussing these guidelines and the evidence that supports them. First, the epidemiology and diverse clinical manifestations of DN are summarized. Then, prevention strategies such as glycemic control, lifestyle modifications and footcare are discussed, as well as the importance of early diagnosis. Finally, neuropathic pain management strategies and promising novel therapies under investigation such as neuromodulation devices and nutraceuticals are reviewed. Full article
(This article belongs to the Special Issue Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment)
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16 pages, 4808 KiB  
Review
Pathogenesis of Distal Symmetrical Polyneuropathy in Diabetes
by Sasha Smith, Pasha Normahani, Tristan Lane, David Hohenschurz-Schmidt, Nick Oliver and Alun Huw Davies
Life 2022, 12(7), 1074; https://doi.org/10.3390/life12071074 - 19 Jul 2022
Cited by 13 | Viewed by 4827
Abstract
Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying [...] Read more.
Distal symmetrical polyneuropathy (DSPN) is a serious complication of diabetes associated with significant disability and mortality. Although more than 50% of people with diabetes develop DSPN, its pathogenesis is still relatively unknown. This lack of understanding has limited the development of novel disease-modifying therapies and left the reasons for failed therapies uncertain, which is critical given that current management strategies often fail to achieve long-term efficacy. In this article, the pathogenesis of DSPN is reviewed, covering pathogenic changes in the peripheral nervous system, microvasculature and central nervous system (CNS). Furthermore, the successes and limitations of current therapies are discussed, and potential therapeutic targets are proposed. Recent findings on its pathogenesis have called the definition of DSPN into question and transformed the disease model, paving the way for new research prospects. Full article
(This article belongs to the Special Issue Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment)
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Other

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10 pages, 230 KiB  
Case Report
Diabetic Neuropathic Cachexia: A Clinical Case and Review of Literature
by Alessio Bellelli, Daniele Santi, Manuela Simoni and Carla Greco
Life 2022, 12(5), 680; https://doi.org/10.3390/life12050680 - 4 May 2022
Cited by 2 | Viewed by 2532
Abstract
A 46-year-old man was admitted to the surgical department because of abdominal pain and anemia, with the radiological finding of a perforated duodenal ulcer, and underwent laparoscopic surgical treatment. Type 2 diabetes mellitus (T2DM) had been diagnosed 5 years earlier and treated with [...] Read more.
A 46-year-old man was admitted to the surgical department because of abdominal pain and anemia, with the radiological finding of a perforated duodenal ulcer, and underwent laparoscopic surgical treatment. Type 2 diabetes mellitus (T2DM) had been diagnosed 5 years earlier and treated with diet. At clinical investigation, the patient was depressed and anorexic; moreover, he complained of lower extremity weakness and bilateral feet pain, burning in nature and accompanied by allodynia. This painful sensation had been preceded by an 8-month history of fatigue and anorexia with profound weight loss of 35 kg. After clinical evaluation and a nerve conduction study, diagnosis of diabetic cachectic neuropathy was made based on the rapid onset of severe neuropathic pain in the context of diabetic neuropathy, marked weight loss, and depressed mood. The therapy with pregabalin and duloxetine had scarce effect and was gradually discontinued. The patient, however, obtained progressive relief and amelioration of neuropathic lower-limb pain concomitant with weight gain. This clinical trend also confirmed the diagnosis of this rare form of diabetic neuropathy. A few cases of diabetic neuropathic cachexia have been reported in the literature and are briefly reviewed here. Full article
(This article belongs to the Special Issue Peripheral Diabetic Neuropathy: Symptoms, Causes and Treatment)
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