Highlights
- •Management of DPN starts with risk factors control and lifestyle intervention.
- •There are no universally accepted pathogenetic-based drugs for diabetic neuropathy.
- •Pain management may start with pregabalin/gabapentin/duloxetine.
- •If not effective, they may be switched, or 2nd-line agents/combination should be used.
Abstract
Diabetic neuropathy is a neurodegenerative disorder that may alter both the somatic
and autonomic peripheral nervous systems in the context of diabetes mellitus (DM).
It is a prevalent and burdensome chronic complication of DM, that requires timely
management. Optimized glycemic control (mainly for type 1 DM), multifactorial intervention
(mainly for type 2 DM), with lifestyle intervention/physical exercise, and weight
loss represent the basis of management for diabetic distal symmetrical polyneuropathy,
and should be implemented early in the disease course. Despite better understanding
of the pathogenetic mechanisms of diabetic peripheral neuropathy, there is still a
stringent need for more pathogenetic-based agents that would significantly modify
the natural history of the disease. The paper reviews the available drugs and current
recommendations for the management of distal symmetrical polyneuropathy, including
pain management, and for diabetic autonomic neuropathy. Evaluation of drug combinations
that would perhaps be more efficient in slowing the progression of the disease or
even reversing it, and that would provide a better pain management is still needed.
Keywords
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- New perspective in diabetic neuropathy: from the periphery to the brain, a call for early detection, and precision medicine.Front Endocrinol (Lausanne). 2020; 10
Article info
Publication history
Published online: August 16, 2021
Accepted:
August 10,
2021
Received in revised form:
August 5,
2021
Received:
March 31,
2021
Identification
Copyright
© 2021 Elsevier Inc. All rights reserved.
