Possible Management of Diabetic Neuropathy in Childhood
Authors:
J. Vojtková; P. Ďurdík; M. Čiljaková; L. Vojarová; P. Bánovčin
Authors‘ workplace:
Klinika detí a dorastu, Jesseniova lekárska fakulta Univerzity Komenského a Martinská fakultná nemocnica, Martin
prednosta prof. MUDr. P. Bánovčin, CSc.
Published in:
Čes-slov Pediat 2010; 65 (4): 186-194.
Category:
Review
Overview
Diabetic neuropathy (DN) presents one of the most common chronic complications of diabetes mellitus (DM). Incidence of DN depends on metabolic control and duration of diabetes, however genetic and other factors are very important, too. Several pathways of neuropathy onset and development have been found – polyol pathway, non-enzymatic glycation of proteins, oxidative stress, decreased function of trans-membrane pump Na+K+ATP-ase, lower concentration of neural growth factor (NGF), activation of protein-kinase C and others. These processes lead to functional or structural damage of nerves either directly or through vasa nervorum microangiopathy.
In childhood, subclinical forms and cardiovascular autonomic neuropathy are often met. The therapy of DN is despite of extensive trials still insufficient. Diabetes control is regarded as the only proved therapeutic intervention improving chronic diabetic complications. Using of thioctic acid and vitamins group B is quite frequent however the beneficial effect is controversial. Other possible interventions are in experimental trials, till now. Recent studies have proved beneficial influence of C-peptide substitution which can increase Na+K+ATP-ase function and prevent development of microangiopathy vasa nervorum by induction of NO-synthetase. Inhibitors of aldose-reductase (epalrestat, fidarestat) inhibit the rate-limiting enzyme in polyol pathway. Low amount of NGF can be influenced by its substitution or stimulation by all-trans retinoic acid. Capturers of carbonyl groups (pyridoxamine, aminoguanidine) act in prevention of advanced glycation end products origin. Protein-kinase C activity can be influenced by its inhibitors (ruboxistaurin). New possibility in future therapy presents therapy “made-to-measure” according to known gene polymorphisms for certain enzymes.
Unfortunately, despite extensive theoretical knowledge, practical possibilities with proved beneficial effect on DN consist in optimal diabetes control. Thioctacid and vitamins have only supportive effect. Additional clinic studies are necessary to confirm the benefit of other methods.
Key words:
diabetic neuropathy, glycemic control, pathogenesis, therapy
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Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
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