What are the treatment options for neuropathy in type 2 diabetes mellitus (DM)?

Updated: Oct 23, 2019
  • Author: Romesh Khardori, MD, PhD, FACP; Chief Editor: George T Griffing, MD  more...
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Answer

Peripheral neuropathy is the most common complication observed in patients with type 2 diabetes in outpatient clinics. Patients may have paresthesias, numbness, or pain. The feet are involved more often than the hands.

Improved glycemic control early may alleviate some of the symptoms, although sometimes symptoms actually worsen with lowering of blood glucose levels. Later symptomatic therapy largely is empirical and may include the following:

  • Low-dose tricyclic antidepressants

  • Duloxetine

  • Anticonvulsants (eg, phenytoin, gabapentin, carbamazepine)

  • Topical capsaicin

  • Various pain medications, including nonsteroidal anti-inflammatory drugs (NSAIDs)

Protection of the feet by applying lubricating agents (but not between the toes) and wearing appropriate footwear (shoes and socks or stockings) is important. Daily inspection of the feet after bathing is mandatory. In patients with advanced neuropathy, water temperature must be checked by a companion or with a thermometer. Soaking the feet generally is not recommended and may be harmful.


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