Whither pathogenetic treatments for diabetic polyneuropathy?

Andrew J M Boulton, P. Kempler, Alexander Ametov, Dan Ziegler

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Diabetic distal symmetric polyneuropathy (DSPN) occurs in around one-third of patients with diabetes and is associated with significant morbidity and increased mortality. Diagnosis and clinical assessment of DSPN remain a challenge, not only for the physician in clinical practice but also for clinical trials. Optimal diabetes control is generally considered an essential first step in the prevention and management of DSPN. However, glycaemic control alone may be insufficient to prevent the development or progression of DSPN, especially in type 2 diabetes. Near-normoglycaemia is also difficult to achieve in a significant proportion of patients. Although considerable advances have been made in symptomatic pain management, these have not addressed the problem of sensory deficits and have no impact on the underlying pathogenesis of DSPN. There remains a lack of treatment options that effectively target the natural history of the disease. Several pathogenetic treatment approaches have been investigated, but evidence from clinical trials is limited with a number of treatments having shown disappointing results. However, some pathogenetic therapies have shown clinically relevant improvements in neuropathic endpoints in randomised controlled trials, in particular α-lipoic acid and Actovegin. These advances in DSPN disease modification need to be confirmed with further robust evidence from clinical trials together with a better understanding of the mechanisms of action of promising treatments.

Original languageEnglish
Pages (from-to)327-333
Number of pages7
JournalDiabetes/Metabolism Research and Reviews
Volume29
Issue number5
DOIs
Publication statusPublished - Jul 2013

Fingerprint

Polyneuropathies
Diabetic Neuropathies
Clinical Trials
Therapeutics
Thioctic Acid
Pain Management
Type 2 Diabetes Mellitus
Randomized Controlled Trials
Morbidity
Physicians
Mortality

Keywords

  • Diabetic peripheral neuropathy
  • Glycaemic control
  • Neuropathy diagnosis
  • Pain management
  • Pathogenetic treatment

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine

Cite this

Whither pathogenetic treatments for diabetic polyneuropathy? / Boulton, Andrew J M; Kempler, P.; Ametov, Alexander; Ziegler, Dan.

In: Diabetes/Metabolism Research and Reviews, Vol. 29, No. 5, 07.2013, p. 327-333.

Research output: Contribution to journalArticle

Boulton, Andrew J M ; Kempler, P. ; Ametov, Alexander ; Ziegler, Dan. / Whither pathogenetic treatments for diabetic polyneuropathy?. In: Diabetes/Metabolism Research and Reviews. 2013 ; Vol. 29, No. 5. pp. 327-333.
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