Mecanismos fisiopatológicos de la neuropatía diabética y su evaluación clínica con el cuestionario DN4 y el monofilamento de Semmes Weinstein: revisión narrativa
DOI:
https://doi.org/10.53287/rcni9289zs59yPalabras clave:
Neuropatía diabetica, Diabetes mellitus, Monofilamento de Semmes-Weinstein, Cuestionario DN4, Evaluación clínica, Dolor neuropático, DiagnósticoResumen
La Diabetes Mellitus constituye un problema de salud mundial cuya prevalencia en Latinoamérica alcanza entre el 30 y 40 %, llegando incluso al 50 % en algunos reportes, con mayor afectación en adultos mayores de 50 años y predominio femenino. En Bolivia, alrededor de 194 000 personas viven con esta enfermedad y se proyecta que en 2050 sean más de 400 000 casos; estudios locales destacan la neuropatía como complicación más frecuente (81,82 %), seguida de retinopatía, con riesgo elevado de amputación en casos de pie diabético. La neuropatía diabética representa el 75 % de todas las neuropatías, con una frecuencia superior al 30 % en grandes cohortes y hasta un 50 % de pacientes con formas subclínicas. Su fisiopatología incluye hiperglicemia crónica, dislipidemia, estrés oxidativo, inflamación, disfunción mitocondrial, alteraciones en el calcio y daño de células de Schwann, factores que condicionan déficit motor, sensorial y neurodegeneración progresiva. Se han explorado medidas preventivas como antioxidantes, cambios en dieta, ejercicio y neuroestimulación, aunque su aplicación clínica aún requiere mayor validación; no obstante, el estilo de vida saludable y la actividad física (≥150 minutos semanales) muestran eficacia en retrasar complicaciones. Para el diagnóstico temprano destacan métodos no invasivos como el cuestionario DN4, con sensibilidad entre 75–95 % y especificidad de 78–97 %, y el monofilamento de Semmes-Weinstein, con menor sensibilidad (28–57 %) pero útil para detectar pérdida de sensibilidad en miembros inferiores. En conclusión, la neuropatía diabética constituye una complicación frecuente y devastadora de la Diabetes Mellitus, cuyo impacto epidemiológico continuará en ascenso a nivel global —con una proyección de 783 millones de casos en 2045 y 1,31 billones en 2050—, por lo que la detección precoz y las intervenciones preventivas son fundamentales para reducir su carga clínica y social.
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