Title:Current Options and Perspectives in the Treatment of Diabetic Neuropathy
Volume: 19
Issue: 27
Author(s): Tamas Varkonyi, Zsuzsanna Putz, Katalin Keresztes, Timea Martos, Csaba Lengyel, Alin Stirban, Gyorgy Jermendy and Peter Kempler
Affiliation:
Keywords:
Diabetic neuropathy, benfotiamine, alpha-lipoic-acid, gabapentin, pregabalin, duloxetine.
Abstract: We aimed to summarise recent advances in the therapy of diabetic neuropathy. Although all therapeutic choices in the treatment
of diabetes mellitus itself are based on clear pathophysiological basis, this approach is less present in the treatment of the “forgotten
complication”, diabetic neuropathy. As part of pathogenetic oriented treatment, the role of glycemic control and cardiovascular risk factors
are reviewed. The mode of action of benfotiamine is based on inhibition of key alternative pathways, including the polyol, hexosamine,
protein-kinase-C pathways, and inhibition of advanced glycation end products formation, just as on activation of transketolase. Alpha-
lipoic-acid is considered as the most potent antioxidant. Other forms of pathogenetic oriented treatment, including actovegin, will be
summarised. The anticonvulsants gabapentin and pregabalin, as well as the antidepressant duloxetine represent the most important new
drugs among agents for symptomatic relief. Most likely, we should offer combination treatment to our patients much more often, first of
all combination of pathogenetic and symptomatic drugs. Finally, the broad spectrum of non-pharmacological treatment will be reviewed.
