What are the new treatments for Diabetic Neuropathy (DN)?

From the Guidelines

New treatments for diabetic neuropathy include several promising options beyond traditional pain medications, with pregabalin (Lyrica) at 150-300mg daily and duloxetine (Cymbalta) at 60-120mg daily remaining first-line pharmacological treatments, as recommended by the most recent guidelines 1. These treatments typically require 2-4 weeks for noticeable effect. Some key points to consider when treating diabetic neuropathy include:

• The use of topical treatments like capsaicin 8% patches applied for 30-60 minutes every 3 months and lidocaine 5% patches applied for up to 12 hours daily to painful areas 1.
• Spinal cord stimulation therapy has shown effectiveness for pain reduction in patients not responding to first-line treatments 1.
• Emerging treatments include sodium channel blockers like BIIB074 and Nav1.7 inhibitors that target specific pain pathways 1.
• Non-pharmacological approaches are also advancing, with structured exercise programs (30 minutes of moderate activity 3-5 times weekly) showing benefits for nerve function and pain reduction 1.
• Combination therapy often works best, addressing both symptom management and potential disease modification 1. It's essential to note that early treatment is crucial as it may prevent progression of nerve damage while improving quality of life through pain management 1. The decision to use a particular treatment should take into account patient co-morbidities and costs, and optimization of glycaemic control and aggressive management of cardiovascular risk factors are also clearly important 1.

From the FDA Drug Label

1. 4 Diabetic Peripheral Neuropathic Pain in Adults 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 (Study DPNP-1 and Study DPNP-2).

Duloxetine is a treatment for diabetic neuropathy. The drug label supports the use of duloxetine delayed-release capsules for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults.

• The efficacy of duloxetine was established in two 12-week trials, Study DPNP-1 and Study DPNP-2.
• 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 2

From the Research

New Treatments for Diabetic Neuropathy

• Diabetic neuropathy is a common complication of diabetes mellitus, affecting up to 50% of patients during their lifetime, and can lead to numbness, tingling, pain, and loss of sensation in the extremities 3.
• Current treatments for diabetic neuropathy focus on preventative care and pain management, with four FDA-approved drugs for painful diabetic neuropathy: pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch 3, 4.
• Nonpharmacological treatments such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) show promise in reducing pain in diabetic patients 3, 4.
• Recent updates on treating painful diabetic peripheral neuropathy highlight the importance of lifestyle modifications, intensive glucose control, and symptomatic pain relief, with a focus on the most recently approved management options, including SCS devices and the capsaicin 8% topical system 4.
• Comparison of the efficacy of duloxetine and pregabalin in pain relief associated with diabetic neuropathy shows that both medications are effective, with duloxetine showing lower VAS scores than pregabalin at 12 weeks 5.
• Pregabalin is a first-line treatment for painful diabetic neuropathy, offering consistent relief of pain and an acceptable tolerance level, but may have adverse effects such as somnolence and dizziness 6.

Emerging Therapies

• Neuromodulation devices and nutraceuticals are promising novel therapies under investigation for the management of diabetic neuropathy 7.
• Other strategies, such as tricyclic antidepressants, serotonin/norepinephrine reuptake inhibitors, gabapentinoids, and sodium channel blockers, may be used as part of individualized comprehensive pain management plans 4.
• Further research is needed to evaluate the effects of these emerging therapies and to develop more effective management strategies for diabetic neuropathy.