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2015 ; 12
(1-2
): 63-83
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Treating Diabetic Neuropathy: Present Strategies and Emerging Solutions
#MMPMID26676662
Javed S
; Alam U
; Malik RA
Rev Diabet Stud
2015[Spr]; 12
(1-2
): 63-83
PMID26676662
show ga
Diabetic peripheral neuropathies (DPN) are a heterogeneous group of disorders
caused by neuronal dysfunction in patients with diabetes. They have differing
clinical courses, distributions, fiber involvement (large or small), and
pathophysiology. These complications are associated with increased morbidity,
distress, and healthcare costs. Approximately 50% of patients with diabetes
develop peripheral neuropathy, and the projected rise in the global burden of
diabetes is spurring an increase in neuropathy. Distal symmetrical polyneuropathy
(DSPN) with painful diabetic neuropathy, occurring in around 20% of diabetes
patients, and diabetic autonomic neuropathy (DAN) are the most common
manifestations of DPN. Optimal glucose control represents the only broadly
accepted therapeutic option though evidence of its benefit in type 2 diabetes is
unclear. A number of symptomatic treatments are recommended in clinical
guidelines for the management of painful DPN, including antidepressants such as
amitriptyline and duloxetine, the ?-aminobutyric acid analogues gabapentin and
pregabalin, opioids, and topical agents such as capsaicin. However, monotherapy
is frequently not effective in achieving complete resolution of pain in DPN.
There is a growing need for head-to-head studies of different single-drug and
combination pharmacotherapies. Due to the ubiquity of autonomic innervation in
the body, DAN causes a plethora of symptoms and signs affecting cardiovascular,
urogenital, gastrointestinal, pupillomotor, thermoregulatory, and sudomotor
systems. The current treatment of DAN is largely symptomatic, and does not
correct the underlying autonomic nerve deficit. A number of novel potential
candidates, including erythropoietin analogues, angiotensin II receptor type 2
antagonists, and sodium channel blockers are currently being evaluated in phase
II clinical trials.
|Autonomic Nervous System Diseases/*drug therapy
[MESH]