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Mikroangiopathie, dysfunktionale Schwann-Zell-Interaktion, Akkumulation toxischer Metabolite und inflammatorische Prozesse f\u00fchren gemeinsam zur Nervensch\u00e4digung.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ziel der Arbeit<\/jats:title><jats:p>Aus- und \u00dcberblick zum aktuellen Kenntnisstand der Pathophysiologie mit aktuellen und zuk\u00fcnftigen Therapieimplikationen.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methoden<\/jats:title><jats:p>Literaturrecherche (1990\u20132020).<\/jats:p><\/jats:sec><jats:sec><jats:title>Ergebnisse<\/jats:title><jats:p>Klinisch f\u00fchrend sind sensible und autonome Symptome, Paresen k\u00f6nnen jedoch auftreten. Komplikationen wie stumme Myokardinfarkte oder das diabetische Fu\u00dfsyndrom k\u00f6nnen lebensbedrohlich verlaufen und zu schwerer Behinderung f\u00fchren. In ihrer Pathophysiologie unterscheiden sich Neuropathien bei Typ-1- und Typ-2-Diabetikern durch die Gegenwart zus\u00e4tzlicher Risikofaktoren des metabolischen Syndroms. Die intensivierte ist der konventionellen Insulintherapie im Hinblick auf die Neuropathierisikoreduktion \u00fcberlegen. Orale Antidiabetika sind nach Nebenwirkungsprofil auszuw\u00e4hlen. Metformin kann zu einem iatrogenen Vitamin-B12-Mangel f\u00fchren. Zur Behandlung neuropathischer Schmerzen besitzt der Kalziumkanalblocker Pregabalin die h\u00f6chste Empfehlungsstufe. Das Trizyklikum Amitriptylin gilt als \u00e4hnlich wirksam, ist aber bei autonomer Dysfunktion sowie kognitiven Einschr\u00e4nkungen kontraindiziert. Alternativ ist der Serotonin-Noradrenalin-Wiederaufnahmehemmer Duloxetin zur symptomatischen Therapie der diabetischen Neuropathie zugelassen. Umstritten sind weitere, zum Teil nicht zugelassene Medikamente wie \u03b1\u2011Lipons\u00e4ure, Epalrestat und L\u2011Serin.<\/jats:p><\/jats:sec><jats:sec><jats:title>Schlussfolgerungen<\/jats:title><jats:p>Die diabetische Neuropathie ist h\u00e4ufig und komplikationsreich. Ein gutes Verst\u00e4ndnis der Pathophysiologie kann zur Entwicklung neuer Therapiestrategien beitragen.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00115-020-00948-3","type":"journal-article","created":{"date-parts":[[2020,7,9]],"date-time":"2020-07-09T07:37:50Z","timestamp":1594280270000},"page":"714-721","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Ursachen, Spektrum und Therapie der diabetischen Neuropathie","Causes, spectrum, and treatment of the diabetic neuropathy"],"prefix":"10.1007","volume":"91","author":[{"given":"Maike F.","family":"Dohrn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Natalie","family":"Winter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Dafotakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,7,9]]},"reference":[{"issue":"1","key":"948_CR1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2337\/dc16-2042","volume":"40","author":"R Pop-Busui","year":"2017","unstructured":"Pop-Busui\u00a0R, Boulton\u00a0AJ, Feldman\u00a0EL et al (2017) Diabetic neuropathy: a\u00a0position statement by the American Diabetes Association. 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