Treatment of diabetic neuropathy and neuropathic pain: how far have we come?

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Diabetes Care. 2008 Feb;31 Suppl 2:S255-61.

Treatment of diabetic neuropathy and neuropathic pain: how far have

we come?

Ziegler D.

Institute for Clinical Diabetes Research, German Diabetes Center,

Leibniz Institute at the Heinrich Heine University, Düsseldorf, Germany.

dan.ziegler@...

At least one of four diabetic patients is affected by distal

symmetric polyneuropathy, which represents a major health problem, since

it may present with partly excruciating neuropathic pain and is

responsible for substantial morbidity, increased mortality, and impaired

quality of life. Treatment is based on four cornerstones: 1) causal

treatment aimed at (near)-normoglycemia, 2) treatment based on

pathogenetic mechanisms, 3) symptomatic treatment, and 4) avoidance of

risk factors and complications. Recent experimental studies suggest a

multifactorial pathogenesis of diabetic neuropathy. From the clinical

point of view, it is important to note that, based on these pathogenetic

mechanisms, therapeutic approaches could be derived, some of which are

currently being evaluated in clinical trials. Among these agents, only

alpha-lipoic acid is available for treatment in several countries and

epalrestat in Japan. Although several novel analgesic drugs such as

duloxetine and pregabalin have recently been introduced into clinical

practice, the pharmacologic treatment of chronic painful diabetic

neuropathy remains a challenge for the physician. Individual

tolerability remains a major aspect in any treatment decision.

Epidemiological data indicate that not only increased alcohol

consumption but also the traditional cardiovascular risk factors such as

hypertension, smoking, and cholesterol play a role in development and

progression of diabetic neuropathy and hence need to be prevented or

treated.

PMID: 18227494 [PubMed - indexed for MEDLINE]

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