From the Guidelines
Treatment for diabetic neuropathy should prioritize optimizing glucose control, blood pressure, and serum lipid control, alongside pharmacologic treatments such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers, as recommended by the most recent guidelines 1. The management of diabetic neuropathy involves a multifaceted approach, including lifestyle modifications and pharmacological interventions.
- 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, as emphasized in recent standards of care 1.
- Blood pressure and serum lipid control are also vital in reducing the risk or slowing the progression of diabetic neuropathy.
- Assessing and treating pain related to diabetic peripheral neuropathy and symptoms of autonomic neuropathy is essential to improve quality of life.
- First-line pharmacologic treatments for neuropathic pain in diabetes include gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, and sodium channel blockers, with the specific choice depending on patient comorbidities, potential side effects, and costs, as outlined in the latest recommendations 1.
- For localized pain, topical treatments like capsaicin cream or lidocaine patches can provide relief.
- In severe cases, opioids may be considered but are generally avoided due to the risk of addiction.
- Beyond medications, tight blood glucose control, regular exercise, and proper foot care are crucial components of managing diabetic neuropathy, aiming to prevent further nerve damage and improve quality of life, as supported by evidence from various studies 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
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:
- Lifestyle modifications and intensive glucose control to treat the underlying cause of diabetic neuropathy 4
- Pharmacologic options, such as:
- Non-pharmacologic options, such as:
- Emerging therapies, such as mirogabalin, which has shown efficacy and good tolerability in clinical trials 5
First-Line and Second-Line Therapies
First-line drug therapy for painful diabetic peripheral neuropathy includes:
- Duloxetine 7, 8
- Gabapentin 7
- Amitriptyline 7, 8
- Pregabalin 7, 8 Second-line drug therapy includes:
- Nortriptyline 7
- Imipramine 7
- Venlafaxine 7, 8
- Carbamazepine 7
- Oxcarbazepine 7
- Topical lidocaine 7
- Topical capsaicin 7, 8
Important Considerations
When choosing a treatment for diabetic neuropathy, clinicians should consider the patient's goals, functional status, and potential adverse effects of medication 8. Additionally, periodic, objective monitoring of medication response is critical to ensure that patients are obtaining desired pain reduction and to minimize adverse effects 7.