REVIEW   

Minerva Medica 2017 October;108(5):419-37

DOI: 10.23736/S0026-4806.17.05257-0

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Advances in the management of diabetic neuropathy

Tamás VÁRKONYI ¹ ✉, Anna KÖREI ², Zsuzsanna PUTZ ², Tímea MARTOS ², Katalin KERESZTES ³, Csaba LENGYEL ¹, Szabolcs NYIRATY ¹, Alin STIRBAN ⁴, György JERMENDY ⁵, Péter KEMPLER ²

¹ First Department of Medicine, University of Szeged, Szeged, Hungary; ² First Department of Medicine, Semmelweis University, Budapest, Hungary; ³ First Department of Medicine, Szent István and Szent László Hospital, Budapest, Hungary; ⁴ Sana Klinikum, Remscheid, Germany; ⁵ Third Department of Internal Medicine, Bajcsy-Zsilinszky Hospital, Budapest, Hungary

The authors review current advances in the therapy of diabetic neuropathy. The role of glycemic control and management of cardiovascular risk factors in the prevention and treatment of neuropathic complications are discussed. As further options of pathogenetically oriented treatment, recent knowledge on benfotiamine and alpha-lipoic acid is comprehensively reviewed. Alpha-lipoic acid is a powerful antioxidant and clinical trials have proven its efficacy in ameliorating neuropathic signs and symptoms. Benfotiamine acts via the activation of transketolase and thereby inhibits alternative pathways triggered by uncontrolled glucose influx in the cells comprising polyol, hexosamine, protein-kinase-C pathways and formation of advanced glycation end products. Beyond additional forms of causal treatment, choices of symptomatic treatment will be summarized. The latter is mostly represented by the anticonvulsive agents pregabalin and gabapentin as well as duloxetine widely acknowledged as antidepressant. Finally, non-pharmacological therapeutic alternatives are summarized. The authors conclude that combination therapy should be more often suggested to our patients; especially the combination of pathogenetic and symptomatic agents.

KEY WORDS: Diabetic neuropathies - Thioctic acid - Benphotiamine