Rafiullah Mohamed, Siddiqui Khalid
Strategic Center for Diabetes Research, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
CNS Neurol Disord Drug Targets. 2022;21(10):884-900. doi: 10.2174/1871527320666210303111939.
Neuropathy is the most common complication of diabetes. 50% of adults with diabetes will develop neuropathy in their lifetime. Diabetic peripheral neuropathy (DPN) is the major form of neuropathy found in 75% of diabetic neuropathy incidences. Pharmacological treatments are recommended for pain management in DPN. Anticonvulsants like pregabalin and gabapentin are the preferred first-line treatment, followed by amitriptyline, duloxetine, and venlafaxine. Topical agents like capsaicin and isosorbide dinitrate are also useful in treating the DPN and may be considered for the second or third-line treatment. Opioids and related drugs are suggested for short-term use during the acute exacerbation of pain. Combination therapy may be beneficial in patients who do not respond to monotherapy. However, currently, there is no compelling evidence to suggest any specific combination of agents. Disease-modifying agents such as alpha-lipoic acid and epalrestat appear to improve the disease state but are not recommended by any guideline. This review discusses the available pharmacological therapy for treating DPN. Also, we highlight the recommendations from different guidelines about the pharmacological treatment of DPN.
神经病变是糖尿病最常见的并发症。50%的成年糖尿病患者在其一生中会发生神经病变。糖尿病周围神经病变（DPN）是神经病变的主要形式，见于75%的糖尿病神经病变病例。推荐采用药物治疗来管理DPN的疼痛。普瑞巴林和加巴喷丁等抗惊厥药是首选的一线治疗药物，其次是阿米替林、度洛西汀和文拉法辛。辣椒素和硝酸异山梨酯等局部用药在治疗DPN方面也有作用，可考虑用于二线或三线治疗。建议在疼痛急性加重期间短期使用阿片类药物及相关药物。联合治疗可能对单一疗法无反应的患者有益。然而，目前尚无确凿证据表明任何特定的药物组合。诸如α-硫辛酸和依帕司他等改善病情的药物似乎可改善疾病状态，但未被任何指南推荐。本综述讨论了用于治疗DPN的现有药物治疗方法。此外，我们强调了不同指南关于DPN药物治疗的建议。
