ABSTRACT

Diabetes mellitus is a serious chronic disease that significantly impairs the quality of life of patients worldwide. It is also one of the top ten leading causes of adult mortality, with an estimated four million deaths worldwide in 2017 due to diabetes. The global prevalence of diabetes mellitus reached 9.3% (463 million people) in 2019 and is expected to increase to 10.2% (578 million) by 2030 and 10.9% (700 million) by 2045. The increasing prevalence of diabetes has led to an increased incidence of chronic diabetic complications. Diabetic peripheral neuropathies are frequently encountered as a common chronic complication of diabetes mellitus. This article reviews the etiology and pathogenesis of diabetic peripheral neuropathies, current diagnostic methods, and therapeutic approaches to treatment, including the role of acetylcholine and the efficacy of Ipidacrine (Neuromidine) in the therapy of this pathology.

KEYWORDS: diabetes mellitus, diabetic polyneuropathy, Ipidacrine, Neuromidin

For citation: Rachin A.P., Sharov M.N., Karpov S.M., Rachin S.A., Prokofieva Y.S., Parsamyan R.R. Diabetic Polyneuropathy: from Pathogenesis to Therapy and Prevention (to Help the General Practitioner). Comorbidity Neurology. 2024; 1 (3): 101-108. https://doi.org/10.62505/3034-185x-2024-1-3-101-108.

*For correspondence: Andrei P. Rachin, Dr. Sci. (Med.), Professor, President of the National Association of Experts in Comorbid Neurology, Moscow, Russia, e-mail: 7851377@gmail.com.

REFERENCES

1.Trikkalinou A., Papazafiropoulou A.K., Melidonis A. Type 2 diabetes and quality of life. World J Diabetes 2017; 8: 120-9. https://doi.org/10.4239/wjd.v8.i4.120

2.Saeedi P., Petersohn I., Salpea P., et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9(th) edition. Diabetes Res Clin Pract 2019; 157: 107843. https://doi.org/10.1016/j.diabres.2019.107843

3.Barrett A.M., Lucero M.A., Le T., et al. Epidemiology, public health burden, and treatment of diabetic peripheral neuropathic pain: a review. Pain Med 2007; 8 Suppl 2: S50-62. https://doi.org/10.1111/j.1526-4637.2006.00179.x

4.Tesfaye S., Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev 2012; 28 Suppl 1:8-14. https://doi.org/10.1002/dmrr.2239

5.Ang L., Jaiswal M., Martin C., et al. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep 2014; 14: 528. https://doi.org/10.1007/s11892-014-0528-7

6.Pop-Busui R., Lu J., Brooks M.M., et al. Impact of glycemic control strategies on the progression of diabetic peripheral neuropathy in the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) Cohort. Diabetes Care 2013; 36: 3208-15. https://doi.org/10.2337/dc13-0012

7.Martin C.L., Albers J.W., Pop-Busui R., et al. Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care 2014; 37: 31-8. https://doi.org/10.2337/dc13-2114

8.Gylfadottir S.S., Itani M., Krøigård T., et al. Diagnosis and prevalence of diabetic polyneuropathy: a cross-sectional study of Danish patients with type 2 diabetes. Eur J Neurol 2020; 27: 2575-85. https://doi.org/10.1111/ene.14469

9.Kisozi T., Mutebi E., Kisekka M., et al. Prevalence, severity and factors associated with peripheral neuropathy among newly diagnosed diabetic patients attending Mulago hospital: a cross-sectional study. Afr Health Sci 2017; 17: 463-73. https://doi.org/10.4314/ahs.v17i2.21

10.Abdissa D. Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord 2020; 19: 1407-13. https://doi.org/10.1007/s40200-020-00661-7

11.Albers J.W., Pop-Busui R. Diabetic neuropathy: Annals of Palliative Medicine. Ann Palliat Med 2023;12(2):390-398 https://dx.doi.org/10.21037/apm-22-693 

12.Rastogi A., Jude E.B. Novel treatment modalities for painful diabetic neuropathy. Diabetes Metab Syndr 2021; 15: 287-93. https://doi.org/10.1016/j.dsx.2021.01.004

13.Yang S., Kwak S.G., Choi G.S., et al. Short-term Effect of Repetitive Transcranial Magnetic Stimulation on Diabetic Peripheral Neuropathic Pain. Pain Physician. 2022 Mar; 25 (2): E203-E209

14.Min C.C, Seoyon Y. Diabetic peripheral neuropathy essentials: a narrative review. Ann Palliat Med 2023; 12 (2): 390-398. https://dx.doi.org/10.21037/apm-22-693

15.Shtemberg L.V., Karpov S.M., Vyshlova I.A., Raevskaya A.I., Zakharyan E.S., Dolgova I.N. Towards the Prevention of Diabetic Peripheral Polyneuropathy. Comorbidity Neurology. 2024; 1 (1): 53-59. https://doi.org/10.62505/3034-185x-2024-1-1-53-59 (In Russ.)

16.Rachin A.P., Sharov M.N., Rachin S.A.,Prokofieva Y.S., Parsamyan R.R. Diabetic Dorsopathy: from Theory to Practice. Comorbidity Neurology. 2024; 1 (1): 93-101. https://doi.org/10.62505/3034-185x-2024-1-1-93-101 (In Russ.)

17.Sima A., Li, Z. Pathogenesis of diabetic neuropathy: implications for therapy. Nature Reviews Neurology. 2020; 16 (6): 389-404

18.Soroku Yagihashi et al. Pathology and pathogenetic mechanisms of diabetic neuropathy: Correlation with clinical signs and symptoms. Diabetes Research and Clinical Practice. 2007. 77S: S184–S189

19.Khramilin V.N., Strokov I.A., Davydov O.S., Churyukanov M.V. Diagnosis of diabetic polyneuropathy in primary care. Russian Journal of Pain. 2021; 19 (2): 47‑53. https://doi.org/10.17116/pain20211902147 (In Russ.)

20.Callaghan M.M., McCafferty J. Diabetic peripheral neuropathy: current perspectives. Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy. 2018; 11: 1-15

21.Zochodne D.W. Diabetic neuropathy: mechanisms, management, and future directions. Diabetes. 2016; 65 (6): 1816-1825

22.Ghenadieva A., et al. Ipidacrine effects in diabetic neuropathy: a systematic review and meta-analysis. Frontiers in Pharmacology. 2021; 12: 123

23.Hobbiger F. Pharmacology of Anticholinesterase Drugs. In: Zaimis, E., Maclagan, J. (eds) Neuromuscular Junction. Handbuch der experimentellen Pharmakologie / Handbook of Experimental Pharmacology. 1976; 42. Springer, Berlin, Heidelberg

24. Zhivolupov S.A., Vorob'eva M.N., Samartsev I.N., Rashidov N.A. Innovation in differential diagnosis and monitoring of rational therapy in patients with lumbosacral radiculopathies. S.S. Korsakov Journal of Neurology and Psychiatry. 2014; 114 (8): 25‑31. (In Russ.)

25.Bakhtereva E.V., Shirokov V.A., Leĭderman E.L., Terechov N.L., Varaksin A.N., Panov V.G. An effect of ipidacrine (neuromidin) on electroneuromyographic parameters in the conditions of artificial decompression (a clinical/instrumental study). S.S. Korsakov Journal of Neurology and Psychiatry. 2017; 117(1): 25‑28. https://doi.org/10.17116/jnevro20171171125-28 (In Russ.)

26.Dzyak L.A., Shulga A.N., Tsurkalenko E.S. Efficiency of Neuromidin in the Treatment of Diabetic Polyneuropathy. Ukrainian Bulletin of Psychoneurology. 2007. 15 (2): 135-138 (In Russ.)

27.Salazar Intriago M.S., Piovesana R., Matera A., et al. The Mechanisms Mediated by α7 Acetylcholine Nicotinic Receptors May Contribute to Peripheral Nerve Regeneration. Molecules. 2021; 26 (24): 7668. https://doi.org/10.3390/molecules26247668

28.Verdiyan E.E., Allakhverdiev E.S., Maksimov G.V. Study of the Peripheral Nerve Fibers Myelin Structure Changes during Activation of Schwann Cell Acetylcholine Receptors. PLoS One. 2016 Jul 25; 11 (7):e0158083. https://doi.org/10.1371/journal.pone.0158083

29.Piovesana R., Reid A..J, Tata A.M. Emerging Roles of Cholinergic Receptors in Schwann Cell Development and Plasticity. Biomedicines. 2023; 11 (1): 41. https://doi.org/doi: 10.3390/biomedicines11010041

30.Romeiko D.I. et al. Efficiency of Neuromidin® in the treatment of diabetic distal polyneuropathy. Medical news. 2009; 6: 82-85 (In Russ.)

31.ИМП Нейромидин таб 20 мг 20.01.2022, ИМП Нейромидин р-р 5 и 15 мг/мг от 31.01.2022 31. 

32.Spallone V., et al. Diabetic neuropathies: diagnosis and management. Diabetes Care. 2011; 34 (Suppl. 2): S200-S207

ADDITIONAL INFORMATION

Andrei P. Rachin, Dr. Sci. (Med.), Professor, President of the National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: 7851377@gmail.com. ORCID: https://orcid.org/0000-0003-4266-0050

Mikhail N. Sharov, Dr. Sci. (Med.), Professor, Department of Nervous Diseases, Faculty of Dentistry, Russian University of Medicine, Moscow, Russia. E-mail: 6112286@mail.ru. ORCID: https://orcid.org/0000-0001-9634-346X

Sergey M. Karpov, Dr. Sci. (Med.), Professor, Head of the Department of Neurology, Neurosurgery and Medical Genetics, Stavropol State Medical University, Stavropol, Russia. E-mail: karpov25@rambler.ru. ORCID: https://orcid.org/0000-0003-1472-6024 

Sergei A. Rachin, Executive Director, National Association of Experts in Comorbid Neurology, Moscow, Russia. E-mail: Rachin.sergei@gmail.com. ORCID: https://orcid.org/0000-0001-9771-4621

Yulia S. Prokofieva, postgraduate student of the Department of Nervous Diseases, Faculty of Dentistry, Russian University of Medicine; Research Center of Neurology, Moscow, Russia. E-mail: pryulek@yandex.ru. ORCID: https://orcid.org/0000-0003-4454-7174

Ruzanna R. Parsamyan, Cand. Sci. (Med.), Associate Professor of the Department of Neurology named after. K.N. Tretyakova; Senior Researcher at the Department of Basic Research in Neurocardiology, Research Institute of Cardiology, Saratov State Medical University named after V.I. Razumovsky; Head of Clinic Pain, Saratov, Russia. E-mail: kvl.prr@mail.ru. ORCID: https://orcid.org/0000-0002-6509-5958

Author contributions. All authors confirm the compliance of their authorship, according to international ICMJE criteria (all authors made a significant contribution to the development of the concept, research and preparation of the article, read and approved the final version before publication). Rachin S.A., Prokofieva Yu.S., Parsamyan R.R. – searched for suitable literature; Rachin A.P., Sharov M.N., Karpov S.M. – correcting the text in accordance with the basic requirements.

Funding. This study was supported by any external sources of funding.

Disclosure. The authors declare that they have competing interests.

The content is available under the Creative Commons Attribution 4.0 License.

©2024. Andrei P. Rachin, Mikhail N. Sharov, Sergey M. Karpov et al.