Treatment of diabetic peripheral neuropathy: a review
الخلاصة
Abstract
Objectives This review surveys current pharmacotherapies available for the
treatment of diabetic peripheral neuropathy (DPN), emphasising their mechanisms
of action.
Methods A comprehensive literature review focusing on the ‘pharmacotherapy
and treatment of diabetic peripheral neuropathy’ was conducted. The Database
of International Pharmaceutical Abstracts, EMBASE, PubMed, OVID, Scopus,
Google and Google Scholar were searched, and reference lists of relevant articles
were also included.
Key findings Diabetic peripheral neuropathy is often inadequately treated, and
the role of improving glycaemic control specifically in type-2 diabetes remains
unclear. It is crucial to explore the mechanisms of action and effectiveness of
available therapies. Major international clinical guidelines for the management of
DPN recommend several symptomatic treatments. First-line therapies include
tricyclic antidepressants, serotonin–noradrenaline reuptake inhibitors, and anticonvulsants
that act on calcium channels. Other therapies include opioids and
topical agents such as capsaicin and lidocaine. The objectives of this paper are to
review current guidelines for the pharmacological management of DPN and to
discuss research relevant to the further development of pharmacological recommendations
for the treatment of diabetic neuropathy.
Summary Diabetic neuropathy is a highly prevalent, disabling condition, the
management of which is associated with significant costs. Evidence supports the
use of specific anticonvulsants and antidepressants for pain management in
patients with diabetic peripheral neuropathy. All current guidelines advise a personalised
approach with a low-dose start that is tailored to the maximum
response having the least side effects or adverse events.