Editorial: Frontiers in diagnostic and therapeutic approaches in diabetic sensorimotor neuropathy (original) (raw)

2023, Frontiers in Endocrinology

Editorial on the Research Topic Frontiers in diagnostic and therapeutic approaches in diabetic sensorimotor neuropathy Diabetic neuropathy is a classical interdisciplinary complication in the broadest sense. It still resides on the unattended borderline between internal medicine, including gastroenterology and neurology, as well as many other disciplines. Notwithstanding this, nerve damage is often described as the "forgotten" or "neglected complication" of diabetes (1). Pain and unsteadiness are mainly responsible for impaired quality of life due to neuropathy, while neuropathic damage/deficit is primarily associated with poor prognosis. Among different types of nerve damage, cardiovascular autonomic neuropathy has been shown first to be related to poor prognosis and an increased risk of sudden death. In a 12year-long prospective cohort study among type 1 diabetic patients, sensory damage was associated with a 1,72x higher mortality compared to patients with normal sensory function (2). Sensory neural damage has also been shown as an independent risk factor for myocardial infarction (3). Interestingly, the association between the frequency of myocardial infarction and symptoms of neuropathy was linear, while myocardial infarction frequency was exponentially related to the severity of neuropathic damage (3). According to results of a population-based cohort of patients with type 2 diabetes from the UK Clinical Practice Research Datalink (n = 49027, median follow-up: 5,5 years), the cumulative burden of microvascular disease including peripheral neuropathy significantly increased the risk of future cardiovascular events (4). More recently, over a mean 9-year follow-up, we described a similarly strong association between DPN and all-cause mortality in patients with type 1 and type 2 diabetes mellitus (5). The results were adjusted for several factors including age, sex, anthropometric factors (height, BMI), lifestyle habits (current smoking and alcohol consumption), duration of diabetes, systolic and diastolic blood pressure, antihypertensive treatment, as well as comorbidities (measured using the simplified Charlson comorbidity index) and Frontiers in Endocrinology frontiersin.org 01