Treatment Options for the Management of Diabetic Peripheral Neuropathy
Diabetic peripheral neuropathy affects approximately 60-70% of diabetic patients and a total of 347 million people worldwide.1 This complication is not only associated with painful symptoms, but can also lead to significant consequences such as paresthesia, loss of sensation, ulcers, osteomyelitis, gangrene, foot deformities, and amputation. Common symptoms of diabetic peripheral neuropathy are listed in Table 1. Because the symptoms and complications of diabetic peripheral neuropathy can lead to a significant decrease in a patient's quality of life, it is important to evaluate the effectiveness of the various treatment options available in the management of diabetic peripheral neuropathy.
Unfortunately, treating diabetic peripheral neuropathy can be challenging.1 Although there are several therapeutic options for managing peripheral neuropathy, adherence to treatment is often a concern due to the common side effects associated with these agents. Medications that have been evaluated in the treatment of peripheral neuropathy include antidepressants, anticonvulsants, topical agents, and opioids.
A recent systematic review conducted by Çakici et al analyzed 27 randomized controlled trials (RCTs) to determine the effectiveness of various pharmacological, non-pharmacological, and alternative treatment options used in the management of peripheral neuropathy.1 A total of 19 treatment regimens were assessed in patients with diabetes mellitus to evaluate both neuropathic pain and sensibility symptoms. Primary outcomes of the review included total symptom score (TSS), visual analog scale (VAS), neuropathic pain rating scale, neuropathic pain scale, pain threshold, and neuropathic rating scale. The main results of the meta-analysis are summarized in Table 2.
Several important conclusions were obtained in the analysis by Çakici et al.1 One key finding of the study was the beneficial effect of a-lipoic acid (ALA) in patients with diabetic peripheral neuropathy. Five of the six studies analyzed in their review found that 600mg of oral or intravenous ALA once daily resulted in a statistically significant reduction in TSS. Other interventions that were associated with positive effects on peripheral neuropathy symptoms included opioids, botulinum toxin A, reflexology, and Thai foot massage. Therapies that did not significantly improve symptoms of peripheral neuropathy were micronutrients and photon stimulation therapy.
In their analysis, the authors also discussed the various strengths and limitations of their study.1 One key strength of this review was the inclusion of a broad range of trials that involved pharmacological, non-pharmacological, and alternative methods for treating diabetic peripheral neuropathy. Unfortunately, however, there was only one RCT that met the author's inclusion criteria that evaluated currently used medications, such as antidepressants or antipsychotics. Additional limitations of this analysis include a lack of uniformity in patient characteristics across studies, and short study lengths and follow-up times during the studies.
Peripheral neuropathy is a common complication of diabetes mellitus that is associated with a significantly decreased quality of life. A recent meta-analysis by Çakici et al found that ALA, opioids, botulinum toxin A, reflexology, and Thai foot massage have beneficial effects on the symptoms of diabetic peripheral neuropathy.
1. Çakici N, Fakkel TM, van Neck JW, Verhagen AP, Coert JH. Systematic review of treatments for diabetic peripheral neuropathy. Diabet Med. 2016 Nov; 33(11):1466-1476. DOI:10.1111/dme.13083.