Diabetic polyneuropathy

Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev 2007. 

Barbano RL, Herrmann DN, Hart-Gouleau S, et al. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Arch Neurol. 2004 61 914-918. 

Wellmer A, Misra VP, Sharief MK, Kopelman PG, Anand P. 2001. A double-blind placebo-controlled clinical trial of recombinant human brain-derived neurotrophic factor (rhBDNF) in diabetic polyneuropathy. J Peripher Nerv Syst 6 204-210. 

Cameron NE, Cotter MA. Role of linolenic acid in diabetic polyneuropathy. In Dyck PJ, Thomas PK, eds. Diabetic Neuropathy. 2nd ed. Saunders, Philadelphia, 1999 pp. 359-367. 

Apfel S C, Kessler J A, Adornato B T, et al. (1998). Recombinant human nerve growth factor in the treatment of diabetic polyneuropathy. NGF Study Group. Neurol. 51 695-702. 

Benfotiamine has also been shown to improve nerve conduction velocity in patients with diabetic polyneuropathy [58]. Interestingly, benfotiamine improved endothelial function in type 11 diabetic patients when tested in a postprandial state after an AGE-rich meal [59]. Currently ongoing Phase 11 clinical trials will reveal whether benfotiamine influences the progression of microvascular complications in diabetic patients. 

Haupt E, Ledermann H, Kopcke W. Benfotiamine in the treatment of diabetic polyneuropathy-a three-week randomized, controlled pilot study (BEDIP study). Int J Clin Pharmacol Ther 2005 43 71-77. 

The SYDNEY trial. The sensory symptoms of diabetic polyneuropathy are improved with alfa-lipoic acid. Diabetes Care. 2003 26 770-776. 

Apfel SC, Schwartz S, Adomato BT et al. Efficacy and safety of recombinant human nerve growth factor in patients with diabetic polyneuropathy A randomized controlled trial. rhNGF Clinical Investigator Group. JAMA 2000 284(17) 2215-21. 

Use In alcoholic solutions for topical administration for chilblains, rheumatism, etc. The desensitizing activity on neurons is utilized in neurobiological research. As e.g. Dolenon , C. is applied in therapy of pain and diabetic polyneuropathy. 

Meloxicam is currently under investigation for being used in the treatment of diabetic polyneuropathy. Translational studies from Hokuriku University in Japan demonstrate some positive results. Meloxicam was studied in the treatment of induced diabetic neuropathy in mice. In the study, diabetic mice treated with meloxicam showed improvement in established allodynia when compared with ibuprofen and placebo [4]. These results may lead to further investigation in more animal and human trials. However, with renal impairment and cardiovascular derangements a major concern with many diabetic patients the use of meloxicam in the treatment of diabetic neuropathy could make future human investigation challenging. 

Other unapproved uses other conditions associated with neuropathic pain. Randomized controlled multi-center European studies evaluated Lidoderm for the treatment of neuropathic pain associated with diabetic polyneuropathy. Results show Lidoderm to be as efficacious as systemic analgesics, with substantially fewer systemic side effects. 

Efficacy and safety of 5% lidocaine medicated plaster in comparison with pregabalin in patients with postherpetic neuralgia and diabetic polyneuropathy. Clin DrugInvestig2009 29 2 il-241. 

A variety of mechanisms are brought into play to produce the biological effects of benfotiamine. These include (1) control of redox status, (2) decrease in AGE formation, (3) stimulation of prosurvival G6PD/Akt/Pim-1 pathway, as well as (4) inhibition of glycogen synthase kinase 3. These augment the therapeutic potential of benfotiamine. In clinical studies, treatment with benfotiamine resulted in significant improvement in diabetic polyneuropathy (60). Benfotiamine was also demonstrated to prevent macro- and microvascular endothelial dysfunction in diabetic patients (61). 

Chillies (powdered crude drug/oleoresins and other extracts), capsaicin or capsaicinoids are used internally in atonic dyspepsia and flatulence. However, their use for external purposes is apparently more significant, e.g., for the relief of pains against rheumatic diseases, lumbago, post-herpetic neuralgia or diabetic polyneuropathy in the form of plasters, ointtnents, creams or liniments (Trease and Evans 2002 and references therein Ravishankar et al. 2003). 

Comparative studies Pregabalin and 5% lidocaine in a medicated plaster have been compared in a randomized, open, multicenter, non-inferiority study in 96 patients with post-herpetic neuralgia and 204 with painful diabetic polyneuropathy [265. Overall, 66% of those who used the hdocaine plaster and 62% of those who used pregabalin were considered to have responded. There... 

Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. 5% lidocaine medicated plaster versus pregabalin in post-herpetic neuralgia and diabetic polyneuropathy an open-label, non-inferiority two-stage RCT study. Curr Med Res Opin 2009 25(7) 1663-76. 

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