Diabetic polyneuropathy: what's new?

Objective. The article discusses one of the most common neurological complications of type 2 diabetes mellitus – diabetic polyneuropathy, which is present in every third patient with type 2 diabetes mellitus and is the most common cause of non-traumatic amputation of the lower extremities in most high-income countries.

Results. The available modern data on the pathogenesis, the latest methods of diagnosis and prognosis of diabetic polyneuropathy are summarized. The stages of the symptoms of diabetic polyneuropathy are explained based on modern concepts of the initial lesion of unmyelinated fibers and the further involvement of thicker and well-protected myelinated fibers in the pathological process. Special attention is paid to the indicators available for determination in routine clinical practice and well-known to clinicians: homocysteine, leptin, routine cardiovascular markers, albumin/creatinine ratio, etc. Along with them, progressive biochemical and molecular genetic markers of diabetic polyneuropathy are mentioned, which have the greatest chance of entering clinical work in the near future, such as endocan, the study of the MAPK14 gene. The risk factors for the development of diabetic polyneuropathy in the course of drug and non-drug treatment of type 2 diabetes mellitus and ways to correct them are discussed. Among such factors is a possible deficiency of cyanocobalamin while taking biguanides, thiamine and pyridoxine on the background of restrictive diets. The necessity of their additional subsidies for diabetic polyneuropathy is substantiated. The article presents a modern strategy for pathogenetically based therapy of diabetic polyneuropathy, its place in clinical practice and the expected benefits of its use, not only in the context of replenishing the pool of B vitamins, but also the use of alpha-lipoic acid with antioxidant activity. The trend of recent years is the study of predictors of response to alpha-lipoic acid treatment. Attention is paid to the peculiarities of the pathomorphosis of diabetic polyneuropathy in the context of the new reality created by the COVID-19 pandemic.

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