Emerging therapies for diabetic neuropathy: a clinical overview

This paper reviews emerging interventions from the recent clinical literature that demonstrate the potential for effectiveness in the therapy of the diverse forms of diabetic neuropathy. Diabetic sensorimotor polyneuropathy is the primary focus of this review given that it is the most common form of diabetic neuropathy. For this condition, several promising disease-modifying drugs--including inhibitors of the aldose reductase and protein kinase C metabolic pathways--are currently in phase III development. Additional pharmacological agents with an indication to relieve painful symptoms of diabetic neuropathy have been approved by regulatory agencies in the past year. Therapies for other forms of diabetic neuropathy are discussed briefly: For example, evidence exists to suggest that immunomodulation may be effective for diabetic lumbosacral plexoradiculoneuropathy ('diabetic amyotrophy'), and is effective in diabetic patients with chronic inflammatory demyelinating polyneuropathy regardless of the coexistence of diabetic sensorimotor polyneuropathy. Furthermore, strategies for the management of autonomic neuropathies are itemized. As a whole, current evidence suggests that diabetic neuropathy should not be dismissed as an untreatable disorder, and physicians need to focus on the accurate diagnosis of this complication in order to subsequently offer appropriate therapy to patients.