Algorithms of treatment in the diabetic neuropathy

Abstract

Diabetic neuropathy is a serious chronic complication of diabetes. It is responsible for the occurrence of severe neuropathic pain that significantly worsens the patient’s quality of life. It is also a proven risk factor for development of diabetic foot syndrome or sudden death. Pathogenesis of diabetic neuropathy combines two factors: metabolic and microvascular. Diagnosis of diabetic neuropathy is based on clinical symptoms and signs, nerve conduction studies and autonomic function tests. Other possible mechanisms of impairment of the peripheral nervous system should be considered, but in typical cases further diagnosis is not necessary. Prevention and pathogenetic treatment consists of optimalisation of glucose control with special avoidance of hypoglycemia in conjunction with treatment of hypertension and hyperlipidemia. Treatment aimed at pathogenetic factors consists of alpha lipoic acid, benfothiamine and ACE inhibitors. Symptomatic treatment is useful when clinical symptoms significantly decrease the patient’s quality of life. Treatment of neuropathic pain includes antidepressants, anticonvulsants, opioid-like and opioid analgetics, topical creams and physiotherapy. The goal of autonomic disorder management is to control tachycardia, orthostatic hypotension, gastroparesis, diarrhoea and constipation, urine retention, erectile impotence and sweating disorders.