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当前位置：国际临床研究杂志 > 2026年 10卷 (4)期

Open Access Article

International Journal of Clinical Research. 2026; 10: (4) ; 6-12 ; DOI: 10.12208/j.ijcr.20260172.

Treatment status and research progress of diabetic peripheral neuropathy
糖尿病周围神经病变的治疗现状和研究进展

作者： 刘宇¹, 李若楠² *

1大理大学临床医学院云南大理

2云南省第三人民医院内分泌科云南昆明

*通讯作者：李若楠,单位：云南省第三人民医院内分泌科云南昆明; ；

发布时间: 2026-04-27 总浏览量: 23

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摘要

目的综述糖尿病周围神经病变（diabetic peripheral neuropathy, DPN）的治疗现状及最新研究进展，为临床优化诊疗决策提供参考。方法基于近期国内外指南、系统性评价、随机对照试验及重要临床研究，对DPN的病因治疗、疼痛管理、新型疗法及并发症预防策略进行归纳与评述。结果 DPN的规范管理强调在强化血糖控制基础上，联合营养神经、抗氧化、改善微循环等对因治疗。疼痛管理一线药物包括普瑞巴林、度洛西汀等，新型钙通道调节剂（如米罗加巴林）及局部用药（如高浓度辣椒素贴片）显示出优势。基因疗法（如VM202）、干细胞治疗、钠通道阻滞剂（如维索三嗪）等新兴策略在临床试验中展现出潜力。智能可穿戴设备为并发症预防提供了新工具。结论 DPN治疗需采取多靶点、个体化的综合策略。未来需进一步验证新型疗法的长期疗效与安全性，并探索基于发病机制的精准治疗。

关键词： 糖尿病周围神经病变；药物治疗；新兴疗法；疼痛管理

Abstract

Objective To review the current status of treatment and the latest research progress of diabetic peripheral neuropathy (DPN), and to provide a reference for the optimization of clinical diagnosis and treatment decisions.
Methods Based on recent domestic and international guidelines, systematic reviews, randomized controlled trials and important clinical studies, the etiological treatment, pain management, novel therapeutic methods and complication prevention strategies for DPN were summarized and commented on.
Results Standardized management of DPN emphasizes etiological treatments such as neurotrophic therapy, antioxidant therapy and microcirculation improvement in combination with intensive glycemic control. First-line drugs for pain management include pregabalin and duloxetine; novel calcium channel modulators (e.g., mirogabalin) and topical agents (e.g., high-concentration capsaicin patches) have shown advantages. Emerging strategies such as gene therapy (e.g., VM202), stem cell therapy and sodium channel blockers (e.g., vixotrigine) have demonstrated potential in clinical trials. Intelligent wearable devices provide a new tool for the prevention of complications.
Conclusion The treatment of DPN requires a multi-target and individualized comprehensive strategy. Future research needs to further verify the long-term efficacy and safety of novel therapeutic methods, and explore precision therapy based on the pathogenesis of DPN.

Key words： Diabetic peripheral neuropathy; Pharmacological treatment; Emerging therapies; Pain management

参考文献 References

[1] 中华医学会糖尿病学分会. 中国糖尿病防治指南（2024版）[J]. 中华糖尿病杂志,2025,17(1):16-139.

[2] 中华医学会疼痛学分会,中国医师协会疼痛科医师分会,蒋宗滨,等. 痛性糖尿病周围神经病变药物治疗中国专家共识[J]. 中国疼痛医学杂志,2025,31(10):721-732.

[3] Wang CS, Pai YW, Lin CH, Lee IT, Chen HH, Chang MH. Diabetic peripheral neuropathy: age-stratified glycemic control. Front Endocrinol (Lausanne). 2024 Apr 17;15:1377923.

[4] 靳升,谢建军,李琳,等. 维生素B12缺乏对2型糖尿病足溃疡影响的临床研究[J]. 当代医药论丛,2023,21(8):35-38.

[5] Gao L, Ran X, Liu X, Shen X, Chen S, Liu F, Zhao D, Bi Y, Su Q, Lu Y, Lei M, Wang Y, Ji L. The effects of daily dose and treatment duration of metformin on the prevalence of vitamin B12 deficiency and peripheral neuropathy in Chinese patients with type 2 diabetes mellitus: A multicenter cross-sectional study. J Diabetes. 2023 Sep;15(9):765-776.

[6] Liu C, Wu T, Ren N. Glucagon-like peptide-1 receptor agonists for the management of diabetic peripheral neuropathy. Front Endocrinol (Lausanne). 2024 Jan 19;14:1268619.

[7] Halloum W, Dughem YA, Beier D, Pellesi L. Glucagon-like peptide-1 (GLP-1) receptor agonists for headache and pain disorders: a systematic review. J Headache Pain. 2024 Jul 12;25(1):112.

[8] Didangelos T, Karlafti E, Kotzakioulafi E, Margariti E, Giannoulaki P, Batanis G, Tesfaye S, Kantartzis K. Vitamin B12 Supplementation in Diabetic Neuropathy: A 1-Year, Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients. 2021 Jan 27;13(2):395.

[9] 李辉星,李勇. 硫辛酸治疗糖尿病周围神经病变临床疗效[J]. 养生保健指南,2023(20):112-114.

[10] Orellana-Donoso M, López-Chaparro M, Barahona-Vásquez M, Santana-Machuca A, Bruna-Mejias A, Nova-Baeza P, Valenzuela-Fuenzalida JJ. Effectiveness of alpha-lipoic acid in patients with neuropathic pain associated with type I and type II diabetes mellitus: A systematic review and meta-analysis. Medicine (Baltimore). 2023 Nov 3;102(44):e35368.

[11] 张立飞,包春艳. 依帕司他在糖尿病周围神经病变患者中的应用效果分析[J]. 糖尿病天地,2024,21(2):7-8.

[12] 路璐. 依帕司他对2型糖尿病周围神经病变Keap1/ Nrf2/ARE通路的影响研究[J]. 药品评价,2024, 21(12): 1528-1531.

[13] 丁蕊,赵小艳,冯皓月,等. 血-神经屏障在糖尿病周围神经病变中机制的研究进展[J]. 中国糖尿病杂志,2025, 33(5):378-382.

[14] Guo L, Pan Q, Cheng Z, Li Z, Jiang H, Zhang F, Li Y, Qiu W, Lu S, Tian J, Fu Y, Li F, Li D. Acetyllevocarnitine Hydrochloride for the Treatment of Diabetic Peripheral Neuropathy: A Phase 3 Randomized Clinical Trial in China. Diabetes. 2024 May 1;73(5):797-805.

[15] 王亚伟. 木丹颗粒治疗糖尿病周围神经病变的临床疗效观察[J]. 智慧健康,2024,10(1):110-113.

[16] 孙建,王丹,王亚丽. 木丹颗粒联合不同药物治疗糖尿病周围神经病变疗效[J]. 辽宁中医药大学学报,2024, 26(2):136-139.

[17] Kang SM, Hong JH, Ku BJ. A randomized, active-controlled, parallel, open-label, multicenter, phase 4 study to compare the efficacy and safety of pregabalin sustained release tablet and pregabalin immediate release capsule in type II diabetic patients with peripheral neuropathic pain. Medicine (Baltimore). 2023 Apr 25;102(17):e33701.

[18] Rakusa M, Marolt I, Stevic Z, Rebrina SV, Milenkovic T, Stepien A. Efficacy of Pregabalin and Duloxetine in Patients with Painful Diabetic Peripheral Neuropathy (PDPN): A Multi-Centre Phase IV Clinical Trial-BLOSSOM. Pharmaceuticals (Basel). 2023 Jul 18;16(7):1017.

[19] Cheng ETL, Cheik-Hussein M, Lin N, Lewin AM, McAuley JH, Harris IA. A meta-epidemiological study on the reported treatment effect of pregabalin in neuropathic pain trials over time. PLoS One. 2023 Jan 20;18(1):e0280593.

[20] Pan T, Ma J, Li Y, Wang K, Jiang C, Zhang Y, Liu J, Du R, Zhang W, Bian F, Zhang F, Wang L, Pang S, Ning T, Wang B, Li Y, Wu X, Zhang K, Tang X, Hu H, Sun X, Li P, Cheng Z, Sun J, Yang J, Wang Y, Gao J, Mao H, Li F, Huang Q, Li Y, Peng Z, Guo X. Rapid Onset of Pain Relief with Crisugabalin in Patients with Diabetic Peripheral Neuropathic Pain: Findings from a Multicenter, Randomized, Double-Blind, Controlled Study. Pain Ther. 2025 Aug;14(4):1311-1329.

[21] Guo H, Wang Y, Lv H, Shi B. Efficacy and Safety of Ca2+ Channel α2δ Ligands for the Treatment of Diabetic Peripheral Neuropathic Pain: A Systematic Review and Network Meta-analysis. Pain Ther. 2025 Dec;14(6):1711-1734.

[22] Wu CS, Huang YJ, Ko YC, Lee CH. Efficacy and safety of duloxetine in painful diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Syst Rev. 2023 Mar 21;12(1):53.

[23] Rakusa M, Marolt I, Stevic Z, Rebrina SV, Milenkovic T, Stepien A. Efficacy of Pregabalin and Duloxetine in Patients with Painful Diabetic Peripheral Neuropathy (PDPN): A Multi-Centre Phase IV Clinical Trial-BLOSSOM. Pharmaceuticals (Basel). 2023 Jul 18;16(7):1017.

[24] 孙卓浩,刘妍,周冬梅,等. 阿米替林治疗痛性糖尿病周围神经病变的临床研究[J]. 山东大学学报（医学版）,2015 (5):81-84.

[25] 吕艳华,梁傲雪,李琦. 基于真实世界数据的阿米替林不良事件信号挖掘[J]. 山西医科大学学报,2024,55(6): 798-803.

[26] Sloan G, Teh K, Greig M, Shillo P, Caunt S, Wilkinson ID, Tesfaye S, Selvarajah D. Beyond pain relief: the effects of chronic opioid use on brain structure and function in diabetic neuropathy-a multimodal neuroimaging study. Diabetologia. 2025 Dec;68(12):2867-2878.

[27] Armstrong DG, Bley K, Simpson DM, Staats P, Allen S, Carnevale A, Marcondes L. Diabetic Peripheral Neuropathy: Pathophysiology and New Insights into the Mechanism of Action of High-Concentration Topical Capsaicin. J Exp Pharmacol. 2025 Sep 9;17:651-665.

[28] Überall M, Quandel T, Engelen S, Garcia-Guerra L, Fajri T, Allen S, Freitas R, Kender Z, Eerdekens M. CASPAR: a retrospective cohort study of the high-concentration capsaicin topical system in patients with painful diabetic peripheral neuropathy of the feet. BMJ Open Diabetes Res Care. 2025 May 2;13(3):e004864.

[29] Araya TR, Abad-Santos F, Ortells JMS, Navarro JN, González-López P, Abarca-Olivas J, Ruiz EB, Iglesias-García C, García JFV. Non-Inferiority Study of Two Capsaicin Formulations for Painful Diabetic Neuropathy. Life (Basel). 2025 Sep 24;15(10):1507.

[30] 经加吻,许奇,孟庆波,等. 针灸治疗2型糖尿病及其并发症的机制研究进展[J]. 湖北中医杂志,2025,47(6):62-64,封3-封4.

[31] Petersen EA, Stauss TG, Scowcroft JA, Jaasma MJ, Edgar DR, White JL, Sills SM, Amirdelfan K, Guirguis MN, Xu J, Yu C, Nairizi A, Patterson DG, Creamer MJ, Galan V, Bundschu RH, Mehta ND, Sayed D, Lad SP, DiBenedetto DJ, Sethi KA, Goree JH, Bennett MT, Harrison NJ, Israel AF, Chang P, Wu PW, Argoff CE, Nasr CE, Taylor RS, Caraway DL, Mekhail NA. High-Frequency 10-kHz Spinal Cord Stimulation Provides Long-term (24-Month) Improvements in Diabetes-Related Pain and Quality of Life for Patients with Painful Diabetic Neuropathy. J Diabetes Sci Technol. 2024 Oct 6;20(1):19322968241268547.

[32] Rao VP, Kim YK, Ghazi A, Park JY, Munir KM. Efficacy of recurrent transcutaneous magnetic stimulation in the treatment of diabetic peripheral neuropathy: Multicenter randomized trial. Pain Pract. 2023 Nov;23(8):914-921.

[33] Wong ML, McTeague LM, Gonzalez G, Gonzalez JP, Bolanos JL, Hosein PJ, Cabral DF, Fried PJ. Transcranial magnetic stimulation measures of corticospinal excitability in Black and Hispanic/Latino people with painful peripheral neuropathy. Front Hum Neurosci. 2025 Jun 2;19:1551931.

[34] 任大斌,张义松,郭义君,等. 糖尿病(四肢)周围神经病变松解术治疗现状及研究进展[J]. 中华神经外科疾病研究杂志,2024,18(3):93-96.

[35] Kessler JA, Shaibani A, Sang CN, Christiansen M, Kudrow D, Vinik A, Shin N; VM202 study group. Gene therapy for diabetic peripheral neuropathy: A randomized, placebo-controlled phase III study of VM202, a plasmid DNA encoding human hepatocyte growth factor. Clin Transl Sci. 2021 May;14(3):1176-1184.

[36] Lee N, Nho B, Ko KR, Kim S, Lee J. Gabapentin inhibits the analgesic effects and nerve regeneration process induced by hepatocyte growth factor (HGF) in a peripheral nerve injury model: Implication for the use of VM202 and gabapentinoids for peripheral neuropathy. Mol Cell Neurosci. 2022 Sep;122:103767.

[37] Wu Z, Huang S, Li S, Cai J, Huang L, Wu W, Chen J, Tan J. Bone marrow mesenchymal stem cell and mononuclear cell combination therapy in patients with type 2 diabetes mellitus: a randomized controlled study with 8-year follow-up. Stem Cell Res Ther. 2024 Sep 30;15(1):339.

[38] Alizadeh SD, Jahani S, Rukerd MRZ, Tabrizi R, Masoomi R, Banihashemian SZ, Tabatabaei MSHZ, Ghodsi Z, Pour-Rashidi A, Harrop J, Rahimi-Movaghar V. Human studies of the efficacy and safety of stem cells in the treatment of diabetic peripheral neuropathy: a systematic review and meta-analysis. Stem Cell Res Ther. 2024 Nov 19;15(1):442.

[39] Faber CG, Attal N, Lauria G, Dworkin RH, Freeman R, Dawson KT, Finnigan H, Hajihosseini A, Naik H, Serenko M, Morris CJ, Kotecha M. Efficacy and safety of vixotrigine in idiopathic or diabetes-associated painful small fibre neuropathy (CONVEY): a phase 2 placebo-controlled enriched-enrolment randomised withdrawal study. EClinicalMedicine. 2023 Apr 27;59:101971.

[40] Gilbody A, Gilbody J. Vitamin D for Painful Diabetic Neuropathy: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. Endocrinol Diabetes Metab. 2025 Nov;8(6):e70118.

[41] 高瑞萍,闫晓海,张秀云. 维生素D2治疗糖尿病周围神经病变的临床研究[J]. 四川生理科学杂志,2024,46(10): 2336-2338.

[42] Chen T, Xing X, Huang L, Tu M, Lai X, Wen S, Cai J, Lin S, Zheng Y, Lin Y, Xu L, Qiu Y, Qiu L, Xu Y, Wu P. Efficacy and safety of high-dose intramuscular vitamin D2 injection in type 2 diabetes mellitus with distal symmetric polyneuropathy combined with vitamin D insufficiency: study protocol for a multicenter, randomized, double-blinded, and placebo-controlled trial. Front Endocrinol (Lausanne). 2023 Jul 7;14:1202917.

[43] Ennion L, Hijmans JM. Retention of Improved Plantar Sensation in Patients with Type II Diabetes Mellitus and Sensory Peripheral Neuropathy after One Month of Vibrating Insole Therapy: A Pilot Study. Sensors (Basel). 2024 May 15;24(10):3131.

[44] Orlando G, Brown S, Jude E, Bowling FL, Boulton AJM, Reeves ND. Acute Effects of Vibrating Insoles on Dynamic Balance and Gait Quality in Individuals With Diabetic Peripheral Neuropathy: A Randomized Crossover Study. Diabetes Care. 2024 Jun 1;47(6):1004-1011.

[45] Fuss FK, Tan AM, Weizman Y. Advanced Dynamic Centre of Pressure Diagnostics with Smart Insoles: Comparison of Diabetic and Healthy Persons for Diagnosing Diabetic Peripheral Neuropathy. Bioengineering (Basel). 2024 Dec 8;11(12):1241.

[46] Paton J, Glasser S, Collings R, Marsden J. Getting the right balance: insole design alters the static balance of people with diabetes and neuropathy. J Foot Ankle Res. 2016 Oct 5;9:40.

[47] Horstink KA, van der Woude LHV, Hijmans JM. Effects of offloading devices on static and dynamic balance in patients with diabetic peripheral neuropathy: A systematic review. Rev Endocr Metab Disord. 2021 Jun;22(2):325-335.

引用本文

刘宇, 李若楠, 糖尿病周围神经病变的治疗现状和研究进展[J]. 国际临床研究杂志, 2026; 10: (4) : 6-12.

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