From the Guidelines
To improve diabetic neuropathy, focus on maintaining tight blood glucose control and consider medications such as pregabalin, duloxetine, or gabapentin, as well as lifestyle modifications like regular physical activity and a balanced diet. The primary goal in managing diabetic neuropathy is to alleviate symptoms, improve quality of life, and slow disease progression.
- Maintaining tight blood glucose control is crucial, as it can help prevent or delay the development of neuropathy in people with type 1 diabetes and slow its progression in those with type 2 diabetes 1.
- Medications like pregabalin (Lyrica) 150-300mg daily, duloxetine (Cymbalta) 60-120mg daily, or gabapentin (Neurontin) 900-3600mg daily divided into three doses can be effective in managing neuropathic pain 1.
- Regular physical activity, such as walking 30 minutes daily, can improve circulation and nerve function, while a balanced diet rich in B vitamins (particularly B12 and B6) can help reduce symptoms 1.
- Avoiding alcohol, which can worsen nerve damage, and proper foot care, including daily inspections for injuries and regular podiatrist visits, are also essential 1.
- Topical treatments like capsaicin cream (0.075%) applied 3-4 times daily may provide relief for some patients 1. It is important to note that while glycemic control and lifestyle management are crucial, they may not directly alleviate neuropathic pain, and pharmaceutical interventions may be necessary 1.
- A recent guideline by the American Academy of Neurology recommends that the initial treatment of pain should also focus on the concurrent treatment of both sleep and mood disorders because of increased frequency of these problems in individuals with DPN 1.
- The use of any opioids for management of chronic neuropathic pain carries the risk of addiction and should be avoided 1. Combining multiple strategies typically yields the best results for managing this chronic condition.
From the FDA Drug Label
The efficacy of the maximum recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy was established in three double-blind, placebo-controlled, multicenter studies with three times a day dosing, two of which studied the maximum recommended dose Treatment with pregabalin 100 and 200 mg three times a day statistically significantly improved the endpoint mean pain score and increased the proportion of patients with at least a 50% reduction in pain score from baseline The efficacy of duloxetine delayed-release capsules for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults was established in 2 randomized, 12-week, double-blind, placebo-controlled, fixed-dose trials in adult patients having diabetic peripheral neuropathic pain (DPNP) for at least 6 months Treatment with duloxetine delayed-release capsules 60 mg one or two times a day statistically significantly improved the endpoint mean pain scores from baseline and increased the proportion of patients with at least a 50% reduction in pain scores from baseline
To improve diabetic neuropathy, pregabalin and duloxetine can be used to manage neuropathic pain associated with diabetic peripheral neuropathy.
- Pregabalin can be administered at a dose of 100-200 mg three times a day.
- Duloxetine can be administered at a dose of 60 mg one or two times a day. These treatments have been shown to statistically significantly improve endpoint mean pain scores and increase the proportion of patients with at least a 50% reduction in pain scores from baseline 2 3.
From the Research
Improving Diabetic Neuropathy
To improve diabetic neuropathy, several strategies can be employed, including:
- Optimal glycemic control 4, 5, 6, 7
- Lifestyle and risk factor modification 4, 5, 6, 7
- Footcare and early diagnosis 6
- Neuropathic pain management strategies 4, 5, 6, 7, 8
Pharmacological Treatments
Pharmacological treatments for painful diabetic neuropathy include:
- Pregabalin 4, 5, 7, 8
- Duloxetine 4, 5, 7, 8
- Gabapentin 4, 5
- Amitriptyline 4, 5
- Venlafaxine 4, 5
- Tapentadol 7, 8
- Capsaicin 4, 5, 8
- Opioids (generally avoided) 5
Non-Pharmacological Treatments
Non-pharmacological treatments for diabetic neuropathy include: