Periphere neuropathie bei diabetes

Abstract

Approximately one in three diabetic patients is affected by distal symmetric polyneuropathy (DPN) which on one hand may result in excruciating neuropathic pain and on the other hand in painless foot ulcers leading to reduced quality of life. The prevalence of painful diabetic neuropathy is 8%-26%. Treatment of DPN comprises four appraches: (1) causal treatment aiming at near-normoglycemia, (2) treatment based on pathogenetic considerations, (3) pain treatment, and (4) avoidance of risk factors and complications. Among the pathogenetic treatment options only α-lipoic acid is available in clinical practice for the treatment of neuropathic symptoms and deficits. Neuropathic pain continues to be underdiagnosed and undertreated. Pain treatment primarily includes non-selective monoamine reuptake inhibitors (NSMRI) such as amitriptyline, selective serotonin noradrenaline reuptake inhibitors (SNRI) such as duloxetine, calcium channel α2δ modulators such as pregabalin, as well as weak and strong opioids as second-line drugs or for combination treatment. Non-pharmacological treatment options and psychological support should always be taken into consideration. A thorough risk-benefit estimate is required prior to any adequate treatment aimed at improving or stabilizing patients' long-term quality of life. © 2008 Springer Medizin Verlag.