Effect of intravenous versus subcutaneous insulin delivery on the intensity of neuropathic pain in diabetic subjects.

INTRODUCTION

The effectiveness of treatment of painful diabetic polyneuropathy remains unsatisfactory. The aim of this study was to compare effects of intravenous vs. subcutaneous insulin delivery in patients with diabetic symmetric sensorimotor polyneuropathy on pain relief, the quality of life, sleep disturbance, and the nerve conduction.

MATERIAL AND METHODS

Thirty-four patients with diabetic polyneuropathy (mean age 62 ± 10 years, duration 17 ± 10 years), who reached a pain score over 40 mm on the VAS scale, HbA(1c) 7.5-10%, were randomly assigned to continuous intravenous insulin infusion (examined group) and multiple injections (control subjects). Before and after five days of the insulin treatment the effects on pain relief (SFMPQ-VAS), the quality of life improvement (EuroQol EQ-5D), and sleep disturbances (AIS) were assessed.

RESULTS

Both groups experienced significant pain reduction, improvement of the quality of life, and reduction of sleep disturbances, i.e. a VAS in the study group of 69 ± 14 mm before treatment vs. 40 ± 19 mm after treatment (p < 0.001), and in control subjects 66 ± 16 mm vs. 47 ± 17 mm (p < 0.001). No difference in level of pain intensity reduction between the groups studied was found.

CONCLUSIONS

Intensification of insulin treatment applied for five days results in improvement of the physical condition of patients with painful diabetic polyneuropathy, through pain relief, and improvement of the quality of life and sleep quality. The efficacy of insulin intravenous infusion and multiple injections is comparable.