title: Current options and perspectives in the treatment of diabetic neuropathy.
abstract: We aimed to summarise recent advances in the therapy of diabetic neuropathy. Although all therapeutic choices in the treatment of diabetes mellitus itself are based on clear pathophysiological basis, this approach is less present in the treatment of the "forgotten complication", diabetic neuropathy. As part of pathogenetic oriented treatment, the role of glycemic control and cardiovascular risk factors are reviewed. The mode of action of benfotiamine is based on inhibition of key alternative pathways, including the polyol, hexosamine, protein-kinase-C pathways, and inhibition of advanced glycation end products formation, just as on activation of transketolase. Alpha- lipoic-acid is considered as the most potent antioxidant. Other forms of pathogenetic oriented treatment, including actovegin, will be summarised. The anticonvulsants gabapentin and pregabalin, as well as the antidepressant duloxetine represent the most important new drugs among agents for symptomatic relief. Most likely, we should offer combination treatment to our patients much more often, first of all combination of pathogenetic and symptomatic drugs. Finally, the broad spectrum of non-pharmacological treatment will be reviewed.
authors.affiliation: First Department of Medicine, University of Szeged, Szeged, Hungary. varkonyitamas@gmail.com
authors.forename: Tamás
authors.initials: T
authors.lastname: Várkonyi
authors.forename: Zsuzsanna
authors.initials: Z
authors.lastname: Putz
authors.forename: Katalin
authors.initials: K
authors.lastname: Keresztes
authors.forename: Tímea
authors.initials: T
authors.lastname: Martos
authors.forename: Csaba
authors.initials: C
authors.lastname: Lengyel
authors.forename: Alin
authors.initials: A
authors.lastname: Stirban
authors.forename: György
authors.initials: G
authors.lastname: Jermendy
authors.forename: Peter
authors.initials: P
authors.lastname: Kempler
mesh_terms: D000818:Animals; D000975:Antioxidants / Q000494:pharmacology / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000494:pharmacology / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism / Q000503:physiopathology; D004359:Drug Therapy, Combination; D019317:Evidence-Based Medicine; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000494:pharmacology / Q000627:therapeutic use; D058990:Molecular Targeted Therapy; D012307:Risk Factors
chemical_list: D000975:Antioxidants; D002491:Central Nervous System Agents; D007004:Hypoglycemic Agents