Medical Treatment of Symptomatic Diabetic Neuropathy

Diabetic peripheral neuropathy affects up to 50% of older type 2 diabetic patients: at any time, up to 50% of patients will experience painful or uncomfortable symptoms, some of whom will require symptomatic therapy. The first step in management is to exclude other causes of neuropathy and assess the level of glycaemic control. Recent research suggests that neuropathic pain may be exacerbated by erratic blood glucose control: thus the first aim in management should be to optimize and stabilize glycaemic control. A number of symptomatic therapies have been proven to be efficacious in randomized controlled trials. Whereas the tricyclic drugs are still commonly prescribed, their use is limited by troublesome and predictable side effects. The anticonvulsants Gabapentin and Pregabalin are now widely used in the management of neuropathic pain: the adverse events appear to be superior to the tricyclics. Other promising therapies include Duloxetine and Tramadol. There is also increasing evidence that opioids may be efficacious in some severe cases unresponsive to traditional treatments.