Clinical Manifestations and Current Treatment Options for Diabetic Neuropathies

Carolina M. Casellini, MD; Aaron I. Vinik, MD, PhD, FCP, MACP


Endocr Pract. 2007;13(5):550-566. 

In This Article


Somatic and autonomic neuropathies (DPNs) are among the most common long-term complications of diabetes mellitus and its precursors, impaired glucose tolerance and the metabolic syndrome. DPN is associated with considerable morbidity and mortality and negatively affects quality of life. It is highly prevalent in diabetic populations although often not recognized by physicians. A thorough history and detailed physical examination are essential for the diagnosis. Many simple tests that can be done in the clinic are useful to detect DPN and to predict complications, such as foot ulcers and gangrene. Standardized and validated quantitative measures of disease progression are now available and allow better interpretation of responses to different treatments and study results.

Management of the disease is complex, and the key to success depends, in part, on discovering the underlying pathological processes in each particular clinical presentation. Studies on new agents that target the pathophysiological mechanisms have led to a better understanding of the pathogenesis of DPN as well as the pain mechanisms for the different types of pain syndromes. Two drugs—duloxetine and pregabalin—have recently been approved in the United States for the treatment of neuropathic pain associated with diabetes mellitus. Two decades ago, physicians could only diagnose DPN and commiserate with the patient. This has changed in the last few years with an increasing number of available therapies as the knowledge of the condition continues to grow.


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