Diabetic neuropathy (DN), characterized by nerve damage associated with
diabetes mellitus, belongs among the earliest and most frequent chronic diabetic
complications. It may occur in clinical form (as peripheral sensory/motor, autonomic,
proximal, painful or focal) or in subclinical form detectable just by sensitive diagnostic
methods. The etiology of DN is complex and not fully understood, untill now. Longterm
hyperglycemia triggers a variety of interacting pathways such as production of
advanced glycation end products (AGEs), products of oxidative stress and polyol
pathway, protein kinase C activation, decrease activity of Na+K+ATP-ase, changed
concentration of neural growth factor and production of proinflammatory cytokines.
These pathomechanisms may target directly on nerve cells or on endothelial cells
causing the microangiopathy of vasa nervorum.
According to multicentric studies, duration and poor compensation of diabetes are the
principal risk factors associated with the development of chronic diabetic
complications, so the basis for the management is to maintain adequate metabolic
compensation. Intensified insulin regimen is the most effective in the treatment of
patients with type 1 diabetes. In patients with type 2 diabetes, administration of
selected peroral antidiabetics or insulin therapy is considered. Physical activity,
lifestyle and dietary management also contribute to euglycemia. Currently used
management of DN includes supportive (alpha-lipoic acid, vitamins, antioxidants) and
symptomatic treatment (painkillers, beta blockers, magnetotherapy). Other therapeutic
possibilities are experimental so far. These drugs interfere with the pathophysiological
processes and few of them have been shown to be beneficial in clinical studies (inhibitors of aldose reductase, selective inhibitor of protein kinase C beta, C peptide
substitution), however, the effect of other medicines seems to be controversial
(vascular endothelial growth factor, erythropoietin). This chapter brings comprehensive
review about current possibilities and future perspectives in the management of
diabetic neuropathy.
Keywords: Actovegin, Aldose-reductase inhibitors, Alpha-lipoic acid,
Angiotensin converting enzyme inhibitors, Anti-inflammatory drugs,
Antioxidants, Chronic complications, C-peptide, Diabetes compensation, Diabetes
mellitus, Diabetic neuropathy, Electrical nerve stimulation, Epigenetic
modifications, Erythropoietin, Experimental studies, Growth factors, Kinin B1
receptor, Management, Magnetic field therapy, Neurotrophic factors, Pain relief,
Ruboxistaurin, Spinal cord stimulation, Vascular endothelial growth factor,
Vitamins.
