Author: Malik R.A.

Source: Treatments in Endocrinology, Volume 2, Number 6, 2003 , pp. 389-400(12)

Publisher: Adis International

Abstract:

Diabetic neuropathy is common, related to increased morbidity and mortality, and has no effective treatment at present. Interventions based on putative pathways thought to contribute to damage and repair of nerve fibres have yielded little success to date. Pain is a potentially debilitating manifestation of diabetic neuropathy and has many potential sites of origin and, hence, modulation. Its cause is unclear and it does not respond well to traditional pain therapies, proposed to mediate their benefits via multiple peripheral and central mechanisms. A better understanding of the mechanisms leading to nerve fibre degeneration and regeneration as well as pain has recently resulted in the development of a more targeted approach to the treatment of diabetic neuropathy. Thus, specific NMDA receptor antagonists and more specific neuronal serotonin and norepinephrine (noradrenaline) uptake inhibitors offer promise in the treatment of painful diabetic neuropathy. A number of treatments which include the aldose reductase inhibitors and neurotrophins have failed to reach the clinical arena. However, the antioxidant alpha-lipoic acid, as well as compounds which correct vascular dysfunction and hence neuropathy, such as ACE inhibitors and protein kinase C- inhibitors, have demonstrated more success.

Keywords: Diabetic neuropathies, treatment; Antiepileptic drugs, therapeutic use; Tricyclic antidepressants, therapeutic use; Serotonin reuptake inhibitors, therapeutic use; ACE inhibitors, therapeutic use; Aldose reductase inhibitors, therapeutic use; Thioctic acid, therapeutic use; Protein kinase C inhibitors, therapeutic use; Vascular endothelial growth factor, therapeutic us; Research and development; HMG CoA reductase inhibitors, therapeutic use

Document Type: Review article

Affiliations: 1: Department of Medicine, Manchester Royal Infirmary, Manchester, UK

Publication date: 2003-01-01

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