[Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy].
BACKGROUND
The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease.


OBJECTIVE
To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin.


METHODS
Review of medical records of 17 type-2 diabetic patients, aged 63+/-11 years and a duration of diabetes of 15+/-8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in approximately 0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points.


RESULTS
After 1 year, glycosilated hemoglobin decreased from 10.0+/-1.4% to 7.7+/-1.2% (p approximately =0.003). Pain decreased from 10 to 5.1+/-3.3 at one month, 2.3+/-3.2 at six months, and 3.1+/-3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance.


CONCLUSIONS
The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction.
Bastías A
M Juliana
MJ
Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Toro C
Luis
L
Olmos C
Pablo
P
D018759:Adrenergic Uptake Inhibitors / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000588:Amines / Q000008:administration & dosage; D000700:Analgesics / Q000008:administration & dosage*; D002997:Clomipramine / Q000008:administration & dosage; D003509:Cyclohexanecarboxylic Acids / Q000008:administration & dosage; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D003929:Diabetic Neuropathies / Q000150:complications / Q000188:drug therapy*; D004359:Drug Therapy, Combination; D000077206:Gabapentin; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000188:drug therapy* / Q000209:etiology; D009661:Nortriptyline / Q000008:administration & dosage; D012189:Retrospective Studies; D005680:gamma-Aminobutyric Acid / Q000008:administration & dosage
D018759:Adrenergic Uptake Inhibitors; D000588:Amines; D000700:Analgesics; D002997:Clomipramine; D003509:Cyclohexanecarboxylic Acids; D000077206:Gabapentin; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D009661:Nortriptyline; D005680:gamma-Aminobutyric Acid