FILLING THE GAP: EMERGING TREATMENTS FOR DIABETIC NEUROPATHY

Neuropathy is a common diabetic microvascular complication, which can be associated with significant positive symptoms for the patient, such as numbness, prickling, aching pain, burning pain, lancinating pain, or allodynia, and in advanced cases, may eventually lead to amputation. Currently, no treatments have been approved to prevent or slow the progression of neuropathy. Strict glycemic control has historically been the only method for decreasing a patient’s likelihood of developing neuropathy, but many patients find this level of glycemic control difficult to achieve. Therapies that act on the pathogenesis of neuropathy are therefore being investigated. Trials are ongoing to determine the efficacy of aldose reductase inhibitors, protein kinase C β inhibitors, antioxidants, and antiglycation agents, all of which have shown promise in slowing or stopping the progression of diabetic peripheral neuropathy. Medical management of diabetic neuropathic symptoms has traditionally involved analgesics, antidepressants, and antiepileptic drugs, but often the side effects associated with these agents are substantial, and many patients fail to respond. New symptomatic therapies are therefore being sought. The symptomatic treatments may address painful symptoms over the short term; however they do not address the underlying etiology of neuropathy. This article will review emerging therapies targeting the progression of neuropathy as well as those designed to provide symptomatic relief. (Adv Stud Med. 2004;4(8A):S662-S672)