title: Aldose reductase inhibitors for the prevention and treatment of diabetic peripheral neuropathy.
abstract: OBJECTIVE
  To assess the efficacy of aldose reductase inhibitors in the prevention, reversal or delay in the progression of diabetic peripheral neuropathy.
  
  
  METHODS
  The Cochrane Diabetes Group's database was searched and the citation lists of identified trials and previous reviews checked. Investigators identified as active in the field were approached for overlooked studies.
  
  
  METHODS
  Randomised controlled trials of aldose reductase inhibitors versus placebo, no treatment or other treatment in diabetic patients with or without clinical neuropathy.
  
  
  METHODS
  Nerve conduction velocity was the only end point measured in all trials. Treatment effect was evaluated in terms of nerve conduction velocity mean difference in median and peroneal motor and median and sural sensory nerves.
  
  
  RESULTS
  19 trials, testing 4 different aldose reductase inhibitors for between 4 to 208 weeks duration (median 24 weeks), met the inclusion criteria for the meta-analysis. A small but statistically significant reduction in decline of median and peroneal motor nerve conduction velocities was present in the treated group when compared to the control group (weighted mean 0.66 m/s 95% CI 0.18-1.14 m/s and 0.53 m/s 95% CI 0.02-1.04m/s respectively). No clear benefit of aldose reductase inhibitor treatment was observed in either of the sensory nerves.
  
  
  CONCLUSIONS
  Although aldose reductase inhibitor treatment has been demonstrated to diminsh the reduction in motor nerve conduction velocity, the clinical relevance of such a change in this outcome measure is uncertain. There was no effect in terms of this outcome measure in the smaller sensory fibres, degeneration of which is primarily responsible for the most common neuropathic syndrome associated with diabetes, that of severe pain and loss of sensation in the extremity leading in some cases to ulceration and eventual amputation.
authors.affiliation: Division of Public Health, Nuffield Institute for Health, University of Leeds, 71-75 Clarendon Rd, Leeds, UK, LS9 2PL. hssdrrw@leeds.ac.uk
authors.forename: M
authors.initials: M
authors.lastname: Airey
authors.forename: C
authors.initials: C
authors.lastname: Bennett
authors.forename: A
authors.initials: A
authors.lastname: Nicolucci
authors.forename: R
authors.initials: R
authors.lastname: Williams
mesh_terms: D000449:Aldehyde Reductase / Q000037:antagonists & inhibitors*; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000517:prevention & control; D004791:Enzyme Inhibitors / Q000627:therapeutic use*; D006801:Humans
chemical_list: D004791:Enzyme Inhibitors; D000449:Aldehyde Reductase