Diabetic Polyneuropathy

Diabetic polyneuropathy is a term used to encompass the various forms of peripheral nerve dysfunction that occur in the setting of diabetes. The most common form of diabetic polyneuropathy is distal symmetric polyneuropathy (DSPN), which is a length dependent process typically characterized by numbness, tingling, and occasionally, pain that begins in the feet and slowly progresses more proximally. Besides DSPN, in which distal sensory nerves are predominantly involved, diabetes is also associated with autonomic neuropathies, as well as focal or multifocal neuropathies that can lead to proximal and asymmetric presentations.

The primary treatment for diabetic polyneuropathy is effective glycemic control as this may improve or at least slow progression of the neuropathy.

Another aspect of treatment is the symptomatic management of pain and paresthesias. The American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation have developed an evidence-based guideline for the treatment of painful diabetic neuropathy. Pregabalin, an anticonvulsant, is the only agent in the guideline that has been established as effective for painful diabetic neuropathy. Other probably effective agents are listed below:

Topical agents: Lidocaine 5% patch can be applied to painful areas for 12 hours a day, capsaicin 0.075% applied qid.
Anticonvulsants: gabapentin (100 to 1200 mg tid) and pregabalin (50 to 100 mg tid)
Antidepressants: amitriptyline (10 to 100 mg qhs), nortriptyline (25 to 150 mg qhs), duloxetine (60 to 120 mg daily), and venlafaxine (75 to 225 mg/day).

The American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation have developed an evidencebased guideline for the treatment of painful diabetic neuropathy. Pregabalin, an anticonvulsant, is the only agent in the Other probably effective agents are listed below:

Tramadol (50 mg qid as needed) can be a useful adjunctive analgesic