title: Glucose control and diabetic neuropathy: lessons from recent large clinical trials.
abstract: Diabetic peripheral and autonomic neuropathies are common complications of diabetes with broad spectrums of clinical manifestations and high morbidity. Studies using various agents to target the pathways implicated in the development and progression of diabetic neuropathy were promising in animal models. In humans, however, randomized controlled studies have failed to show efficacy on objective measures of neuropathy. The complex anatomy of the peripheral and autonomic nervous systems, the multitude of pathogenic mechanisms involved, and the lack of uniformity of neuropathy measures have likely contributed to these failures. To date, tight glycemic control is the only strategy convincingly shown to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow the progression of neuropathy in some patients with type 2 diabetes. Lessons learned about the role of glycemic control on distal symmetrical polyneuropathy and cardiovascular autonomic neuropathy are discussed in this review.
authors.affiliation: Department of Internal Medicine, Division of Metabolism, Endocrinology and Diabetes, University of Michigan Medical School, 5329 Brehm Tower 1000 Wall Street, Ann Arbor, MI, 48105, USA.
authors.forename: Lynn
authors.initials: L
authors.lastname: Ang
authors.forename: Mamta
authors.initials: M
authors.lastname: Jaiswal
authors.forename: Catherine
authors.initials: C
authors.lastname: Martin
authors.forename: Rodica
authors.initials: R
authors.lastname: Pop-Busui
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002986:Clinical Trials as Topic; D003922:Diabetes Mellitus, Type 1; D003924:Diabetes Mellitus, Type 2; D003929:Diabetic Neuropathies / Q000097:blood*; D006801:Humans; D011115:Polyneuropathies / Q000097:blood
chemical_list: D001786:Blood Glucose