Treatments for diabetic neuropathy.

The management of symptomatic diabetic sensory neuropathy presents a therapeutic challenge to the practicing physician. Two approaches are outlined in this article. First, symptomatic therapies, which will not influence the natural history of painful neuropathy, are discussed. These include, in addition to the stable glycemic control, tricyclic drugs, a number of anticonvulsant and antiarrhythmic agents, and opioid-like medications. Topical therapies and nonpharmalogic approaches are also discussed. With the exception of near normoglycemia, treatments that may slow the progression of neuropathy are experimental and include aldose reductase inhibitors, antioxidants, and other agents. Finally, the approach to patients without symptoms but with sensory loss is discussed.