CẬP NHẬT CHẨN ĐOÁN VÀ ĐIỀU TRỊ BỆNH THẦN KINH NGOẠI BIÊN DO ĐÁI THÁO ĐƯỜNG

Abstract

Diabetic peripheral neuropathy comprises several distinct forms. It is frequently overlooked, yet its consequences include chronic pain, loss of protective sensation, foot ulceration and reduced quality of life. This structured narrative review first outlines the classification of these forms, together with their identifying features and management principles, and then updates the diagnosis and treatment of distal symmetric sensorimotor polyneuropathy (DSPN) and its painful phenotype, which account for most of the clinical burden. PubMed/MEDLINE, the Cochrane Library and official national and international guidance were searched up to 31 July 2026. The diagnosis of DSPN remains primarily clinical and combines the history with assessment of small-fiber function, large-fiber function and ankle reflexes. Screening for DSPN, identifying loss of protective sensation and stratifying ulcer risk are three distinct objectives: the 10-g monofilament serves the second of these and, given its low sensitivity in early disease, must not be used to exclude DSPN; nerve conduction studies are required only for atypical presentations or when diagnostic confirmation is needed. Management combines multifactorial risk-factor control and foot protection with individualized use of gabapentinoids, serotonin-norepinephrine reuptake inhibitors or tricyclic antidepressants, starting low, titrating slowly and adjusting the dose for age and renal function. When the response is incomplete, switching drug class or combining agents rationally is usually more useful than prolonged dose escalation, and long-term opioid therapy should be avoided. Alpha-lipoic acid and benfotiamine should be regarded as adjunctive only, since a 2024 Cochrane review found that alpha-lipoic acid probably has little or no effect on neuropathy symptoms at six months. Reliable early markers of small-fiber damage and disease-modifying therapies remain open research questions.