Evidence-based Clinical Treatment of diabetic peripheral neuropathy_Chinese Journal of Evidence-Based Medicine

Authors：

LI Junfeng ,  WEN Chongyuan

Department of Endocrinology,Renmin Hospital of Wuhan University;

Corresponding author：

WEN Chongyuan, Email: base3@sina.com

Keywords：

Diabetic peripheral neuropathy; Aldose reductase inhibitors; Nerve growth factor; Alpha-lipoic acid; Tricyclic antidepressants; Capsaicin cream; Evidence-based treatment

DOI：

10.7507/1672-2531.20090021

Video：

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Objective 　To make individualized evidence-based treatment for patients with diabetic peripheral neuropathy.
Methods 　Based on the clinical questions we raised, evidence was collected and critically assessed. Patients’ preferences was also taken into consideration in the decision-making treatment.
Results 　157 studies were retrieved and finally 15 randomized controlled trials, 14 systematic reviews and meta-analyses, and 1 clinical guidelines were considered eligible. The evidence indicated that the first step in management of patients with diabetic peripheral neuropathy should aim for stable and optimal glycemic control; there was no statistically significant difference between aldose reductase inhibitors and placebo in the treatment of diabetic polyneuropathy, the same to nerve growth factor; alpha-lipoic acid is superior to placebo in reducing symptoms of diabetic peripheral neuropathy; 5-hydroxytryptamine and norepinephrine uptake inhibitor, tricyclic antidepressants and anticonvulsants might alleviate the pain in patients with diabetic peripheral neuropathy; vitamin B and capsaicin cream are is effective and safe in the management of diabetic peripheral neuropathic pain. The individualized treatment plans were developed based on the available evidence. After 3 month of treatment, the blood sugar returned to normal and symptoms were alleviated.
Conclusion 　 The treatment efficacy in diabetic peripheral neuropathy has been improved by determining an individulized treatment plan according to evidence-based methods.

Citation： LI Junfeng,WEN Chongyuan. Evidence-based Clinical Treatment of diabetic peripheral neuropathy. Chinese Journal of Evidence-Based Medicine, 2009, 09(1): 107-112. doi: 10.7507/1672-2531.20090021 Copy

1.	Standards of Medical Care in Diabetes—2008 DIABETES CARE, VOLUME 31, SUPPLEMENT 1, JANUARY 2008.
2.	Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol, 1995, 38(6): 869-880.
3.	Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia, 1996, 39(11): 1377-1384.
4.	Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005, 28: 956-962.
5.	Hotta N, Kawamori R, Atsumi Y, et al. Stratified analyses for selecting appropriate target patients with diabetic peripheral neuropathy for long-term treatment with an aldose reductase inhibitor, epalrestat ADCT Study Group. Diabet Med, 2008, 25(7): 818-825.
6.	Hotta N, Akanuma Y, Kawamori R, et al. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy: the 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial. Diabetes Care, 2006, 29: 1538-1544.
7.	Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev, 2007, 17(4): CD004572.
8.	Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic peripheral neuropathy with alpha- lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia, 1995, 38(12): 1425-1433.
9.	Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res, 1999, 31(3): 171-179.
10.	Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care, 1999, 22(8): 1296-1301.
11.	Ametov AS, Barinov A, Dyck PJ, et al. SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care, 2003, 26(3): 770-776. Erratum in: Diabetes Care, 2003, 26(7): 2227.
12.	Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alphalipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care, 2006, 29(11): 2365-2370.
13.	Ziegler D, Nowak H, Kempler P, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med, 2004, 21(2): 114-121.
14.	Apfel SC, Schwartz S, Adornato BT, et al. Efficacy and safety of recombinant human nerve growth factor in patients with diabetic polyneuropathy: A randomized controlled trial. J Am Med Assoc, 2000, 284(17): 2215-2221.
15.	Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. Journal of Pain and Symptom Management, 2000, 20(6): 449-458.
16.	Joss JD. Tricyclic antidepressant use in diabetic neuropathy. Ann Pharmacother, 1999, 33(9): 996-1000.
17.	McQuay HJ, Tramèr M, Nye BA, et al. A systematic review of antidepressants in neuropathic pain. Pain, 1996, 68(2-3): 217-227.
18.	Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia, 1969, 5(4): 215-218.
19.	Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA, 1998, 280(21): 1831-1836.
20.	Wiffen PJ, McQuay HJ, Edwards JE, et al. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev, 2005, 20(3): CD005452.
21.	Hemstreet B, Lapointe M. Evidence for the use of gabapentin in the treatment of diabetic peripheral neuropathy. Clin Ther, 2001, 23(4): 520-531.
22.	Frampton JE, Scott LJ. Pregabalin: in the treatment of painful diabetic peripheral neuropathy. Drugs, 2004, 64(24): 2813-2820; discussion 2821.
23.	Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care, 2008, 31(7): 1448-1454.
24.	Arezzo JC, Rosenstock J, Lamoreaux L, et al. Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. BMC Neurol, 2008, 16(8): 33.
25.	Chong MS, Hester J. Diabetic painful neuropathy: current and future treatment options. Drugs, 2007, 67(4): 569-585.
26.	Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther, 2007, 29: 2536-2546.
27.	Ang Cynthia D, Alviar Maria Jenelyn M, Dans Antonio L.Vitamin B for treating peripheral neuropathy. Cochrane Database of Systematic Reviews, Issue 3, 2008.
28.	Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes, 1996, 104(4): 311-316.
29.	Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan, 2005, 14(2): 48-54.
30.	Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain, 1999, 83(3): 389-400.
31.	Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther, 1995, 12(2): 111-120.
32.	Mason L, Moore R A, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ, 2004, 328(7446): 991.

1. Standards of Medical Care in Diabetes—2008 DIABETES CARE, VOLUME 31, SUPPLEMENT 1, JANUARY 2008.
2. Effect of intensive diabetes treatment on nerve conduction in the Diabetes Control and Complications Trial. Ann Neurol, 1995, 38(6): 869-880.
3. Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia, 1996, 39(11): 1377-1384.
4. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care, 2005, 28: 956-962.
5. Hotta N, Kawamori R, Atsumi Y, et al. Stratified analyses for selecting appropriate target patients with diabetic peripheral neuropathy for long-term treatment with an aldose reductase inhibitor, epalrestat ADCT Study Group. Diabet Med, 2008, 25(7): 818-825.
6. Hotta N, Akanuma Y, Kawamori R, et al. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy: the 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial. Diabetes Care, 2006, 29: 1538-1544.
7. Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev, 2007, 17(4): CD004572.
8. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic peripheral neuropathy with alpha- lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia, 1995, 38(12): 1425-1433.
9. Reljanovic M, Reichel G, Rett K, et al. Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II). Alpha Lipoic Acid in Diabetic Neuropathy. Free Radic Res, 1999, 31(3): 171-179.
10. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group. Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care, 1999, 22(8): 1296-1301.
11. Ametov AS, Barinov A, Dyck PJ, et al. SYDNEY Trial Study Group. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care, 2003, 26(3): 770-776. Erratum in: Diabetes Care, 2003, 26(7): 2227.
12. Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alphalipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care, 2006, 29(11): 2365-2370.
13. Ziegler D, Nowak H, Kempler P, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med, 2004, 21(2): 114-121.
14. Apfel SC, Schwartz S, Adornato BT, et al. Efficacy and safety of recombinant human nerve growth factor in patients with diabetic polyneuropathy: A randomized controlled trial. J Am Med Assoc, 2000, 284(17): 2215-2221.
15. Collins SL, Moore RA, McQuay HJ, et al. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. Journal of Pain and Symptom Management, 2000, 20(6): 449-458.
16. Joss JD. Tricyclic antidepressant use in diabetic neuropathy. Ann Pharmacother, 1999, 33(9): 996-1000.
17. McQuay HJ, Tramèr M, Nye BA, et al. A systematic review of antidepressants in neuropathic pain. Pain, 1996, 68(2-3): 217-227.
18. Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia, 1969, 5(4): 215-218.
19. Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA, 1998, 280(21): 1831-1836.
20. Wiffen PJ, McQuay HJ, Edwards JE, et al. Gabapentin for acute and chronic pain. Cochrane Database Syst Rev, 2005, 20(3): CD005452.
21. Hemstreet B, Lapointe M. Evidence for the use of gabapentin in the treatment of diabetic peripheral neuropathy. Clin Ther, 2001, 23(4): 520-531.
22. Frampton JE, Scott LJ. Pregabalin: in the treatment of painful diabetic peripheral neuropathy. Drugs, 2004, 64(24): 2813-2820; discussion 2821.
23. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care, 2008, 31(7): 1448-1454.
24. Arezzo JC, Rosenstock J, Lamoreaux L, et al. Efficacy and safety of pregabalin 600 mg/d for treating painful diabetic peripheral neuropathy: a double-blind placebo-controlled trial. BMC Neurol, 2008, 16(8): 33.
25. Chong MS, Hester J. Diabetic painful neuropathy: current and future treatment options. Drugs, 2007, 67(4): 569-585.
26. Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther, 2007, 29: 2536-2546.
27. Ang Cynthia D, Alviar Maria Jenelyn M, Dans Antonio L.Vitamin B for treating peripheral neuropathy. Cochrane Database of Systematic Reviews, Issue 3, 2008.
28. Stracke H, Lindemann A, Federlin K. A benfotiamine-vitamin B combination in treatment of diabetic polyneuropathy. Exp Clin Endocrinol Diabetes, 1996, 104(4): 311-316.
29. Sun Y, Lai MS, Lu CJ. Effectiveness of vitamin B12 on diabetic neuropathy: systematic review of clinical controlled trials. Acta Neurol Taiwan, 2005, 14(2): 48-54.
30. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain, 1999, 83(3): 389-400.
31. Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther, 1995, 12(2): 111-120.
32. Mason L, Moore R A, Derry S, et al. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ, 2004, 328(7446): 991.

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