Diabetic Polyneuropathy: from Pathogenesis to Pathogenetic Therapy

The growing worldwide prevalence of prediabetes and diabetes mellitus (DM) has led to an increase in the incidence of related chronic complications, the most common of which is diabetic polyneuropathy (DPN). The development of DPN is caused by chronic hyperglycemia and potentially modifiable cardiovascular risk factors, including elevated triglyceride levels, body mass index, smoking and hypertension. Social determinants of health are also risk factors for DPN. The review presents data on the pathophysiology of DPN with consideration of the causes of the sequence of symptoms. Discussed the mechanisms and significance of mitochondrial damage, metabolic disorders and regulatory functions of Schwann cells, and issues of autophagy. Noted the role of factors such as hyperglycemia, dyslipidemia, insulin resistance and microvascular disorders, described the signaling pathways and epigenetic changes associated with DPN. Emphasized the role of lifestyle changes and behavioral interventions in the comprehensive management of patients with lesions of the peripheral nervous system in DM. Highlighted modern approaches to the treatment of diabetic neuropathy from the point of view of the mechanisms leading to its progression, as well as unresolved issues and prospects are outlined.