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Precision Medicine for Diabetic Neuropathy

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Abstract

Diabetic peripheral neuropathy (DPN) is the most prevalent diabetic and prediabetic complication and leads to substantial morbidity. The most common manifestation is distal symmetric polyneuropathy, which can present with tingling, pain, and loss of sensory function. A precision medicine-based approach to DPN requires a nuanced understanding of evolving concepts in its underlying pathophysiology, as DPN due to type 1 (T1D) and type 2 (T2D) diabetes represents largely different disease processes. In T1D, aggressive glycemic control significantly reduces the progression of DPN, while in T2D, there is only a modest benefit. There is growing evidence that metabolic syndrome, obesity, and dyslipidemia contribute to the development of DPN, particularly in T2D. Emerging data, based largely on murine models, now identifies potentially viable dyslipidemic, mitochondrial, substrate uptake and transport, as well as inflammatory therapeutic targets. In addition, DPN neuropathic pain is becoming more precisely phenotyped and classified using such modalities as functional MRI, quantitative sensory testing, and even genomic data. Targeted pain treatment remains challenging due to the inability to guide drug selection based on patient profile at the present time. Through the use of predictive models, the goal is to individualize treatments based on a more nuanced understanding of underlying pathogenesis and pain processes.

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Acknowledgements

LD, AMS, SAS, and ELF are supported by the NeuroNetwork for Emerging Therapies at the University of Michigan

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Authors and Affiliations

  1. Department of Neurology, University of Michigan, Ann Arbor, MI, USA

    Long Davalos, Amro M. Stino, Stacey A. Sakowski & Eva L. Feldman

  2. Department of Oncology and Metabolism, Medical School, University of Sheffield, Sheffield, UK

    Dinesh Selvarajah

  3. Diabetes Research Unit, Sheffield Teaching Hospital, Sheffield, UK

    Solomon Tesfaye

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  1. Long Davalos
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  2. Amro M. Stino
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  3. Dinesh Selvarajah
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  4. Stacey A. Sakowski
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  5. Solomon Tesfaye
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  6. Eva L. Feldman
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Corresponding authors

Correspondence to Solomon Tesfaye or Eva L. Feldman .

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  1. Division of Endocrinology, University of Virginia, Charlottesville, VA, USA

    Rita Basu

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Davalos, L., Stino, A.M., Selvarajah, D., Sakowski, S.A., Tesfaye, S., Feldman, E.L. (2022). Precision Medicine for Diabetic Neuropathy. In: Basu, R. (eds) Precision Medicine in Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-030-98927-9_8

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