Diabetes: how to manage diabetic peripheral neuropathy

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Megha Gandhi, Emily Fargo, Lalita Prasad-Reddy, Katherine M Mahoney, Diana Isaacs

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Diabetic peripheral neuropathy (DPN) is a major complication of diabetes mellitus. Tight glycaemic management focused on lowering haemoglobin A1C and increasing time in the target glucose range along with metabolic risk factor management form the cornerstone of DPN prevention. However, there is limited evidence supporting the efficacy of glycaemic and metabolic control in reducing the symptoms and complications of DPN, including pain once painful DPN develops. DPN treatments include pharmacological agents and non-pharmacological interventions such as foot care and lifestyle modifications. Pharmacological agents primarily address pain symptoms, which affect 25–35% of people with DPN. First-line agents include the anticonvulsants pregabalin and gabapentin, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine, and secondary amine tricyclic antidepressants, including nortriptyline and desipramine. All agents have unique pharmacological, safety and clinical profiles, and agent selection should be guided by the presence of comorbidities, potential for adverse effects, drug interactions and costs. Even with the current treatment options, people are commonly prescribed less than the recommended dose of medications, leading to poor management of DPN symptoms and treatment discontinuation. By keeping up with the latest therapy algorithms and treatment options, healthcare professionals can improve the care for people with DPN.

Keywords: anticonvulsants, antidepressants, diabetes, hyperglycaemia, neuropathy, pain.

Citation: Gandhi M, Fargo E, Prasad-Reddy L, Mahoney KM, Isaacs D. Diabetes: how to manage diabetic peripheral neuropathy. Drugs Context. 2022;11:2021-10-2. https://doi.org/10.7573/dic.2021-10-2

Contributions: MG, LPR, EF and DI contributed to the initial writing of the manuscript. MG organized references and edited content. KM edited and provided a significant addition to content based on reviewer feedback. DI provided the final round of edits. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole and have given their approval for this version to be published.

Disclosure and potential conflicts of interest: The authors declare that they have no conflicts of interest relevant to this manuscript. The International Committee of Medical Journal Editors (ICMJE) Potential Conflicts of Interests form for the authors is available for download at: https://www.drugsincontext.com/wp-content/uploads/2022/05/dic.2021-10-2-COI.pdf

Acknowledgements: We would like to recognize Kelly L Close for her support in producing this review, and for her continued efforts as a patient advocate for people with diabetes through Close Concerns, The diaTribe Foundation and dQ& A.

Funding declaration: There was no funding associated with the preparation of this article.

Copyright: Copyright © 2022 Gandhi M, Fargo E, Prasad-Reddy L, Mahoney KM, Isaacs D. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0, which allows anyone to copy, distribute and transmit the article provided it is properly attributed in the manner specified below. No commercial use without permission.

Correct attribution: Copyright © 2022 Gandhi M, Fargo E, Prasad-Reddy L, Mahoney KM, Isaacs D. https://doi.org/10.7573/dic.2021-10-2. Published by Drugs in Context under Creative Commons License Deed CC BY NC ND 4.0.

Article URL: https://www.drugsincontext.com/diabetes-how-to-manage-diabetic-peripheral-neuropathy

Correspondence: Diana Isaacs, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, Ohio, USA. Email: isaacsd@ccf.org

Provenance: Invited; externally peer reviewed.

Submitted: 1 October 2021; Accepted: 9 May 2022; Publication date: 14 June 2022.

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