THERAPEUTIC MANAGEMENT OF DIABETIC POLYNEUROPATHY: FROM GLYCEMIC CONTROL TO PAIN MANAGEMENT
DOI:
https://doi.org/10.56238/isevmjv5n1-003Keywords:
Diabetic Polyneuropathies, Diabetes Mellitus, Neuropathic Pain, Glycemic Control, Pregabalin, Alpha-Lipoic AcidAbstract
Diabetic polyneuropathy (DPN) is the most common chronic complication of Diabetes Mellitus, affecting more than 50% of patients and severely impacting quality of life. This narrative review analyzes recent scientific evidence on the therapeutic management of DPN, ranging from pathophysiology to pain control. The pathogenesis is multifactorial, involving oxidative stress, advanced glycation, and microvascular dysfunction, which result in symmetric distal axonal damage (the “glove-and-stocking” pattern). Diagnosis remains essentially clinical, based on medical history and sensory testing using monofilaments and tuning forks. Therapeutic strategies are based on three pillars: strict metabolic control (glycemic and lipid), pathogenetic interventions (alpha-lipoic acid and benfotiamine), and management of neuropathic pain. For symptomatic relief, first-line agents such as pregabalin, duloxetine, and amitriptyline have demonstrated efficacy, with growing evidence (OPTION-DM study) supporting combination therapies for refractory cases. It is concluded that a multidimensional and individualized approach is essential to delay disease progression and reduce the risk of severe outcomes, such as ulcerations and amputations.
References
Attal, N., & Bouhassira, D. (2015). Pharmacological treatment of neuropathic pain. Pain, 156(4 Suppl. 1), S104–S114.
Brownlee, M. (2005). The pathobiology of diabetic complications: A unifying mechanism. Diabetes, 54(6), 1615–1625.
Callaghan, B. C., Cheng, H. T., Stables, C. L., Smith, A. L., & Feldman, E. L. (2012). Diabetic neuropathy: Clinical manifestations and current treatments. The Lancet Neurology, 11(6), 521–534.
Chang, M. C., & Yang, S. (2023). Diabetic peripheral neuropathy essentials: A narrative review. Annals of Palliative Medicine, 12(2), 390–398.
DCCT Research Group. (1993). Effect of intensive diabetes treatment on the development and progression of neuropathy. Annals of Internal Medicine, 122(8), 561–568.
Dillon, B. R., Ang, L., & Pop-Busui, R. (2024). Spectrum of diabetic neuropathy: New insights in diagnosis and treatment. Annual Review of Medicine, 75, 293–306.
Dworkin, R. H., O’Connor, A. B., Backonja, M., Farrar, J. T., Finnerup, N. B., Jensen, T. S., … Wallace, M. S. (2007). Pharmacologic management of neuropathic pain: Evidence-based recommendations. Pain, 132(3), 237–251.
Elafros, M. A., Andersen, H., Bennett, D. L. H., Savelieff, M. G., Viswanathan, V., Callaghan, B. C., & Feldman, E. L. (2022). Towards prevention of diabetic peripheral neuropathy: Clinical presentation, pathogenesis, and new treatments. The Lancet Neurology, 21(10), 922–936.
Feldman, E. L., Callaghan, B. C., Pop-Busui, R., Zochodne, D. W., Wright, D. E., Bennett, D. L. H., … Nave, K. A. (2019). Diabetic neuropathy. Nature Reviews Disease Primers, 5(1), 42.
Jang, H. N., & Oh, T. J. (2023). Pharmacological and nonpharmacological treatments for painful diabetic peripheral neuropathy. Diabetes & Metabolism Journal, 47(6), 743–756.
Popovic, D., Nikolic, A., & Pavlovic, A. (2021). Diabetic polyneuropathy: Mechanisms and therapeutic strategies. Journal of Diabetes Research, 2021, 1–12.
Tesfaye, S., Sloan, G., Petrie, J., White, D., Bradburn, M., Julious, S., … OPTION-DM Study Group. (2022). Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): A multicentre, double-blind, randomised crossover trial. The Lancet, 400(10353), 680–690.
Tesfaye, S., Boulton, A. J. M., Dyck, P. J., Freeman, R., Horowitz, M., Kempler, P., … Vinik, A. (2011). Diabetic neuropathies: Update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care, 33(10), 2285–2293.
Yang, K., Liu, L., Zhang, J., & Wang, Y. (2022). Progress in the treatment of diabetic peripheral neuropathy. Biomedicine & Pharmacotherapy, 148, 112717.
Zhu, J., Zhou, X., Wang, Y., & Li, J. (2024). Diabetic peripheral neuropathy: Pathogenetic mechanisms and treatment. Frontiers in Endocrinology, 14, 1265372.
Ziegler, D., Tesfaye, S., Spallone, V., Gurieva, I., Al Kaabi, J., Mankovsky, B., … Valensi, P. (2022). Screening, diagnosis and management of diabetic sensorimotor polyneuropathy in clinical practice: International expert consensus recommendations. Diabetes Research and Clinical Practice, 186, 109063.
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
