Current Ideas on the Treatment Of Diabetic Neuropathies

ABSTRACT

Diabetic neuropathies are common and their prevalence is rising with the growth in the global prevalence of type 2 diabetes. Several patterns of neuropathy have now been described, with diabetic sensorimotor polyneuropathy (DPN) being the most common. Autonomic neuropathy, entrapment neuropathies including carpal tunnel syndrome and ulnar neuropathy at the elbow pose additional burdens. DPN can be detected in over half of all diabetic subjects and approximately 20% of all patients with DPN also experience neuropathic pain, a complication with major impacts on quality of life. Currently, the only available treatments for DPN are optimal glucose control and pain management, whereas interventions, beyond optimizing hyperglycemic control, to address the underlying polyneuropathy are not available. Here we review current treatment options and new literature relating to DPN, with an emphasis on novel and emerging treatments.

KEYWORDS:

• Diabetes mellitus
• peripheral nervous system
• diabetic polyneuropathy
• diabetic sensorimotor polyneuropathy
• painful diabetic neuropathy

Financial & competing interests disclosure

D.W. Zochodne has had research funding support from CIHR (Canadian Institutes of Health Research), CDA (Canadian Diabetes Association), JDRF (Juvenile Diabetes Research Foundation) and NIH DDK (National Institutes of Health Diabetes, Digestive and Kidney Diseases). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Key Issues

• Diabetic neuropathies include polyneuropathy (diabetic sensorimotor polyneuropathy [DPN]), focal and entrapment neuropathies, and autonomic neuropathy.

• PDN occurs in approximately 20% of DPN patients and can be intractable.

• Optimal control of hyperglycemia is important in preventing and slowing the progression of DPN with the best evidence for this in type 1 diabetic persons.

• Clinical trials to arrest or reverse underlying DPN have largely been negative.

• Treatment trials for PDN are evolving and include antiepileptic agents, TCAs, opioids, and others, supported by varying levels of evidence.

• New molecular strategies designed to address underlying diabetes-related SNRIs neurodegeneration need to be tested in rigorous and well-designed clinical trials.