Diabetic neuropathy: new strategies for treatment.
Current therapeutic possibilities can be divided into two groups: the pathogenetically oriented and the symptomatic therapy. One of the most important component of etiology-based treatment is the stabilization of glycemic control. Based on efficacy and safety data benfotiamine and alpha-lipoic acid should be considered as first choices among pathogenetically oriented treatments of diabetic neuropathy. Promising data were published about the aldose reductase inhibitor ranirestat. The symptomatic effect of antiepileptic drugs in diabetic painful neuropathy (DPN) is originated from several possible pharmacological properties. Pregabalin and gabapentin have the highest efficacy and the lowest frequency of adverse events among these drugs. Antidepressants also extensively used for symptomatic treatment in DPN. In the last years several studies were published about the benefial effect of duloxetine. Most likely combination therapy will be frequently applied in the future for the treatment of DPN, the optimal choice could be to combine pathogenetically oriented and symptomatic treatment.
Várkonyi
Tamás
T
First Department of Medicine, University of Szeged, Szeged, Hungary. vart@in1st.szote.u-szeged.hu
Kempler
Peter
P
D000449:Aldehyde Reductase / Q000037:antagonists & inhibitors; D000588:Amines / Q000627:therapeutic use*; D000700:Analgesics / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use; D003509:Cyclohexanecarboxylic Acids / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D000068736:Duloxetine Hydrochloride; D000077206:Gabapentin; D006801:Humans; D000069583:Pregabalin; D013831:Thiamine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D008063:Thioctic Acid / Q000627:therapeutic use*; D013876:Thiophenes / Q000627:therapeutic use*; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives* / Q000627:therapeutic use
D000588:Amines; D000700:Analgesics; D000927:Anticonvulsants; D000928:Antidepressive Agents; D000975:Antioxidants; D003509:Cyclohexanecarboxylic Acids; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin; D008063:Thioctic Acid; D000068736:Duloxetine Hydrochloride; D000449:Aldehyde Reductase; D013831:Thiamine; C013835:benphothiamine