[Treatment with an aldose reductase inhibitor in peripheral neuropathy in elderly diabetic patients]

Diabetic neuropathy (DN) is one of the most frequent and severe long-term complications in elderly diabetes. Most scientists believe that onset of chronic complications in diabetics is due to prolonged glycometabolic imbalance. Recently aldose reductase inhibitors (ARI) have been used in the treatment of DN. We studied 100 elderly subjects affected by diabetes mellitus who were treated with tolrestat, an ARI, for a year and a control group who received a placebo. All subjects underwent the following examinations at the start of treatment and then at 8, 24, 42 and 52 weeks: 1. electromyography of the lower and upper limbs', 2. biotensiometric evaluation of the vibratory perception threshold (VPT), 3. glycosylated hemoglobin, 4. hourly glycemic profile, azotemia, creatininemia, hemochrome, cholesterol, triglycerides, bilirubin, electrolytes, protidogram, urine. The patients on tolrestat showed: increased nerve conduction velocity (mean values 2.3 m/sec) of the ulnar nerve; increased nerve conduction velocity (mean values 3.9 m/sec) of the peroneal nerve; reduced VPT at the right and left first toe (mean values 5 and 7 volts respectively); reduced VPT at the right and left malleoli (mean values 10 and 8 volts respectively). The authors recommend prompt, long term ARI treatment be initiated before the onset of evident signs of neuropathy in elderly subjects.