Whither pathogenetic treatments for diabetic polyneuropathy

摘要: Summary Diabetic distal symmetric polyneuropathy (DSPN) occurs in around one-third of patients with diabetes and is associated significant morbidity increased mortality. Diagnosis clinical assessment DSPN remain a challenge, not only for the physician practice but also trials. Optimal control generally considered an essential first step prevention management DSPN. However, glycaemic alone may be insufficient to prevent development or progression DSPN, especially type 2 diabetes. Near-normoglycaemia difficult achieve proportion patients. Although considerable advances have been made symptomatic pain management, these addressed problem sensory deficits no impact on underlying pathogenesis There remains lack treatment options that effectively target natural history disease. Several pathogenetic approaches investigated, evidence from trials limited number treatments having shown disappointing results. some therapies clinically relevant improvements neuropathic endpoints randomised controlled trials, particular α-lipoic acid Actovegin. These disease modification need confirmed further robust together better understanding mechanisms action promising treatments. Copyright © 2013 John Wiley & Sons, Ltd.