Аннотация:Neuropathies are among the commonest of long-term diabetes complications, and the management of chronic sensorimotor distal symmetric polyneuropathy (DPN) presents a significant therapeutic challenge (1,2). DPN may manifest with several diverse clinical presentations, including troublesome, neuropathic pain and, at the other end of the spectrum, the insensitive foot at risk of ulceration. Whereas the former gives rise to many unfamiliar and uncomfortable painful and paresthetic symptoms that impact quality of life (3), foot ulceration, which may lead to amputation, has major social and economic implications for the health care system (4,5).
There are currently two main approaches to DPN therapy. First, there are those treatments that alleviate the persistent painful symptoms in the lower limbs. These include the tricyclic antidepressants, anticonvulsants, opioids, and opioid-like agents; the efficacy of these is supported by multiple randomized controlled trials (RCTs) and, in some cases (e.g., the tricyclic drugs), meta-analyses (1,2,6). The newer agents duloxetine and pregabalin also have confirmed efficacy in several RCTs. However, none of these interventions has any impact on the natural history of the condition, which, until recently, was believed to comprise a progressive loss of nerve fibers.
The second group of therapies consists of those …
