From the Guidelines
Treatment of diabetic neuropathy should prioritize optimizing glucose control, assessing and treating pain, and considering pharmacologic treatments such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers, as recommended by the most recent guidelines 1.
Key Treatment Considerations
- Optimizing glucose control is crucial to prevent or delay the development of neuropathy in people with type 1 diabetes and to slow the progression of neuropathy in people with type 2 diabetes 1.
- Assessing and treating pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy is essential to improve quality of life 1.
- First-line pharmacologic treatments for neuropathic pain in diabetes include gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers 1.
Medication Options
- Gabapentinoids, such as pregabalin and gabapentin, are effective in reducing nerve pain by modulating calcium channels 1.
- Serotonin-norepinephrine reuptake inhibitors, such as duloxetine, are effective in reducing pain signals by increasing serotonin and norepinephrine levels 1.
- Tricyclic antidepressants, such as amitriptyline, can be effective in reducing pain signals, but may have dose-limiting side effects, particularly in older individuals 1.
Lifestyle Modifications
- Tight blood glucose control is essential to prevent further nerve damage 1.
- Physical therapy can help maintain strength and mobility, while proper foot care can prevent complications from loss of sensation 1.
- Lifestyle modifications, including regular exercise, smoking cessation, and limiting alcohol consumption, can improve symptoms and slow progression 1.
Monitoring and Prevention
- Patients should monitor their feet daily for injuries they may not feel due to numbness and wear proper footwear to prevent ulcers that could lead to serious infections 1.
From the FDA Drug Label
Pregabalin is indicated for: Management of neuropathic pain associated with diabetic peripheral neuropathy 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
The treatment options for diabetic neuropathy include:
- Pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy 2
- Duloxetine for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults 3
From the Research
Treatment Options for Diabetic Neuropathy
The treatment options for diabetic neuropathy can be categorized into several areas, including:
- Medications to manage pain and other symptoms
- Lifestyle modifications to control underlying risk factors
- Alternative therapies to alleviate symptoms
Medications for Diabetic Neuropathy
Medications for diabetic neuropathy include:
- First-line drug therapy: duloxetine, gabapentin, amitriptyline, and pregabalin 4, 5, 6
- Second-line drug therapy: nortriptyline, imipramine, venlafaxine, carbamazepine, oxcarbazepine, topical lidocaine, and topical capsaicin 4, 5, 6
- Opioids should generally be avoided due to their potential for adverse effects and addiction 4, 5, 6
Lifestyle Modifications and Alternative Therapies
Lifestyle modifications and alternative therapies for diabetic neuropathy include:
- Exercise and neuromodulation with spinal cord stimulation or transcutaneous electrical nerve stimulation 4
- Acupuncture, alpha-lipoic acid, acetyl-L-carnitine, and other supplements, although evidence for their effectiveness is limited 4, 5, 6
- Controlling underlying risk factors such as poor glycemic control, vitamin B12 deficiency, elevated blood pressure, and obesity 4, 6
Comparison of Treatment Options
Studies have compared the effectiveness of different treatment options for diabetic neuropathy, including:
- A study comparing duloxetine and pregabalin found that duloxetine was noninferior to pregabalin in reducing pain scores 7
- Other studies have found that medications such as sodium valproate, venlafaxine, and opioids can be effective in treating diabetic neuropathic pain, although they may have significant side effects 5, 6