Diabetic Neuropathy--A Review

Gérard Said

Disclosures

Nat Clin Pract Neurol. 2007;3(6):331-340. 

In This Article

Treatment of Diabetic Neuropathy

Preventive Treatment

Prevention of diabetic neuropathy and its complications remains the best strategy. Optimum glycemic control diminishes the risk of developing a disabling peripheral neuropathy, but carries an increased risk of hypoglycemia.[4] Patients with diabetes also need advice about foot care and footware, and about protection of hyposensitive areas and pressure points, to prevent the occurrence of painless ulcers and decrease the risk of bone infection. Prevention and treatment of the 'diabetic foot' are best administered in specialized foot clinics.[60] Pancreas transplantation, which might stabilize the neuropathy,[61] is not yet routinely performed.

Symptomatic Treatment

In focal neuropathy, including cranial nerve palsy, PDN and truncal neuropathy, the disease course is self-limited, with spontaneous recovery within a few months in most cases. Control of pain can be difficult both in LDDP and in focal neuropathies. Carbamazepine, phenytoin, clonazepam, or paracetamol in combination with codeine phosphate can be useful. Tricyclic antidepressants, such as imipramine or amitriptyline, are often effective; the usual dose varies from 30-150 mg per day. Tricyclic antidepressants might aggravate postural hypotension. The recently introduced drugs duloxetine and pregabalin are also useful.

Postural hypotension only requires treatment if it is symptomatic. It is worth trying midodrine (where licensed) before using 9-α-fluorohydrocortisone, which is the most effective treatment for postural hypotension but carries a risk of hypertension.

Treatment of Focal and Multifocal Diabetic Neuropathies

PDN is often very painful, and the pain is frequently resistant to conventional treatments. Treatment with corticosteroids for a few weeks or months can be considered in such cases, along with adjustment of glycemic control.[38,48] It is important to keep in mind that the overall spontaneous prognosis of focal diabetic neuropathies is good.

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