ABSTRACT
Polyneuropathy involving the somatic and autonomic nervous system is re sponsible for substantial morbidity and increased mortality among diabetic patients. Near normoglycemia is now generally accepted as the primary ap proach to prevention of diabetic neuropathy (1,2). However, in diabetic pa tients with advanced stages of peripheral neuropathy, relatively long periods of near-normal glycemic control for several months or even years may be needed to retard the progression of nerve dysfunction (3). Because normogly cemia is not achievable in most diabetic patients, the effects of several medical treatments derived from the pathogenetic concepts of diabetic neuropathy have been evaluated in numerous randomized clinical trials during the past two decades. However, due to various reasons, none of these compounds has been marketed as yet in the major European countries or in the United States. None theless, in symptomatic diabetic neuropathy, additional pharmacological treat ment of painful neuropathic symptoms is frequently required to maintain the patients’ quality of life. Although treatment of pain with antidepressants is effective, it may be of limited value because of frequent adverse reactions (4). Other symptomatic approaches including anticonvulsants, mexiletine, and topical capsaicin either have not been unequivocally effective, have shown only partial effects, or caution has been expressed as to potential neurotoxic
side effects in view of longer term treatment (4). Furthermore, these medica tions are designed to modulate symptoms without influencing the underlying neuropathy.
