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Galosi E, Hu X, Michael N, et al. Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review. Acta Diabetol. 2021;doi: 10.1007/s00592-021-01767-x.
Galosi, E., Hu, X., Michael, N., Nyengaard, J. R., Truini, A., & Karlsson, P. (2021). Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review. Acta diabetologica, . https://doi.org/10.1007/s00592-021-01767-x
Galosi, Eleonora, et al. "Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review." Acta diabetologica vol. (2021). doi: https://doi.org/10.1007/s00592-021-01767-x
Galosi E, Hu X, Michael N, Nyengaard JR, Truini A, Karlsson P. Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review. Acta Diabetol. 2021 Jul 02; doi: 10.1007/s00592-021-01767-x. Epub 2021 Jul 02. PMID: 34213655.
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Acta Diabetol. 2021 Jul 02; doi: 10.1007/s00592-021-01767-x. Epub 2021 Jul 02.

Redefining distal symmetrical polyneuropathy features in type 1 diabetes: a systematic review.

Acta diabetologica

Eleonora Galosi, Xiaoli Hu, Nivatha Michael, Jens Randel Nyengaard, Andrea Truini, Páll Karlsson

Affiliations

  1. Department of Human Neuroscience, Sapienza University, Rome, Italy. [email protected].
  2. Core Center for Molecular Morphology, Section for Stereology and Microscopy, Aarhus University, Aarhus, Denmark.
  3. Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
  4. Department of Pathology, Aarhus University Hospital, Aarhus, Denmark.
  5. Department of Human Neuroscience, Sapienza University, Rome, Italy.
  6. Department of Clinical Medicine, Danish Pain Research Center, Aarhus University, Aarhus, Denmark.

PMID: 34213655 DOI: 10.1007/s00592-021-01767-x

Abstract

Diabetic neuropathy is among the most frequent complications of both type 1 (T1DM) and type 2 diabetes (T2DM) and commonly manifests as a distal symmetrical polyneuropathy (DSPN). Despite evidence that T1DM- and T2DM-related DSPN are separate entities, most of our knowledge on diabetic DSPN derives from studies focused on type 2 diabetes. This systematic review provides an overview of current evidence on DSPN in T1DM, including its epidemiological, pathophysiological and clinical features, along with principal diagnostic tests findings. This review included 182 clinical and preclinical studies. The results indicate that DSPN is a less frequent complication in T1DM compared with T2DM and that distinctive pathophysiological mechanisms underlie T1DM-related DSPN development, with hyperglycemia as a major determinant. T1DM-related DSPN more frequently manifests with non-painful than painful symptoms, with lower neuropathic pain prevalence compared with T2DM-associated DSPN. The overt clinical picture seems characterized by a higher prevalence of large fiber-related clinical signs (e.g., ankle reflexes reduction and vibration hypoesthesia) and to a lesser extent small fiber damage (e.g., thermal or pinprick hypoesthesia). These findings as a whole suggest that large fibers impairment plays a dominant role in the clinical picture of symptomatic T1DM-related DSPN. Nevertheless, small fiber diagnostic testing shows high diagnostic accuracy in detecting early nerve damage and may be an appropriate diagnostic tool for disease monitoring and screening.

Keywords: Distal symmetrical polyneuropathy; Neuropathic pain; Neuropathy; Type 1 diabetes

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