The Diabetic Neuropathies

Practical and Rational Therapy

J. Robinson Singleton, M.D.; A. Gordon Smith, M.D.


Semin Neurol. 2012;32(3):196-203. 

In This Article


In summary, effective management of hyperglycemia, symptom control, and prevention of ulcers and infection through screening and surveillance remain mainstays of diabetic neuropathy management four decades after their introduction. Rational therapies based on evolving understanding of diabetic neuropathy pathogenesis have been largely unsuccessful in humans. This failure may reflect, in part, the advanced neuropathy present in subjects of previous human trials. More sensitive and quantitative measures of early peripheral nerve injury, including skin biopsy for intraepidermal nerve fiber density, and confocal corneal microscopy, hold promise to identify neuropathy patients early in their disease course, when rational treatments may be more effective. At the same time, traditional and rational diabetic neuropathy treatments will be supplemented by novel cell-based therapy and targeted drug delivery