Advances in the management of diabetic neuropathy

Minerva Med. 2017 Oct;108(5):419-437. doi: 10.23736/S0026-4806.17.05257-0. Epub 2017 May 25.

Abstract

The authors review current advances in the therapy of diabetic neuropathy. The role of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are discussed. As further options of pathogenetically oriented treatment, recent knowledge on benfotiamine and alpha-lipoic acid is comprehensively reviewed. Alpha-lipoic acid is a powerful antioxidant and clinical trials have proven its efficacy in ameliorating neuropathic signs and symptoms. Benfotiamine acts via the activation of transketolase and thereby inhibits alternative pathways triggered by uncontrolled glucose influx in the cells comprising polyol, hexosamine, protein-kinase-C pathways and formation of advanced glycation end products. Beyond additional forms of causal treatment, choices of symptomatic treatment will be summarized. The latter is mostly represented by the anticonvulsive agents pregabalin and gabapentin as well as duloxetine widely acknowledged as antidepressant. Finally, non-pharmacological therapeutic alternatives are summarized. The authors conclude that combination therapy should be more often suggested to our patients; especially the combination of pathogenetic and symptomatic agents.

Publication types

  • Review

MeSH terms

  • Adjuvants, Immunologic / administration & dosage
  • Amines / administration & dosage
  • Anticonvulsants / administration & dosage
  • Antidepressive Agents / administration & dosage
  • Antioxidants / therapeutic use*
  • Cardiovascular Diseases / prevention & control*
  • Clinical Trials as Topic
  • Cyclohexanecarboxylic Acids / administration & dosage
  • Diabetic Neuropathies / drug therapy*
  • Drug Therapy, Combination
  • Duloxetine Hydrochloride / administration & dosage
  • Evidence-Based Medicine
  • Gabapentin
  • Humans
  • Pregabalin / administration & dosage
  • Randomized Controlled Trials as Topic
  • Thiamine / administration & dosage
  • Thiamine / analogs & derivatives
  • Thioctic Acid / therapeutic use*
  • Treatment Outcome
  • gamma-Aminobutyric Acid / administration & dosage

Substances

  • Adjuvants, Immunologic
  • Amines
  • Anticonvulsants
  • Antidepressive Agents
  • Antioxidants
  • Cyclohexanecarboxylic Acids
  • Pregabalin
  • gamma-Aminobutyric Acid
  • Gabapentin
  • Thioctic Acid
  • Duloxetine Hydrochloride
  • Thiamine
  • benphothiamine