What is the role of glycemic control in the treatment of diabetic neuropathy?

Updated: Jan 08, 2019
  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Of all treatments, tight and stable glycemic control is probably the most important for slowing the progression of neuropathy. [77] Because rapid swings from hypoglycemia to hyperglycemia have been suggested to induce and aggravate neuropathic pain, the stability of glycemic control may be as important as the actual level of control in relieving neuropathic pain. The Diabetes Control and Complications Trial (DCCT) demonstrated that tight blood sugar control in patients with type 1 diabetes decreased the risk of neuropathy by 60% in 5 years. [24, 78] The effect of tight glycemic control on polyneuropathy in patients with type 2 diabetes or those with impaired glucose tolerance/impaired fasting glucose is not as clear and requires further prospective study. [79]

A 2012 Cochrane review indicates that tight glycemic control prevents the development of clinical neuropathy and reduces nerve conduction and vibration threshold abnormalities in patients with either type 1 or type 2 diabetes. However, tight glucose control also increases the risk of severe hypoglycemic episodes, and this should be considered when assessing its risk/benefit ratio. [80]


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