Pharmacologic options for the management of diabetic peripheral neuropathy

Diabetic peripheral neuropathy, one of the most common late complications of diabetes, is associated with decreased quality of life and increased morbidity. The pathophysiology of diabetic neuropathy (DN) is multifactorial, contributing to ischemic and painful events and neuronal damage. Prevention through strict glycemic control remains the mainstay of the treat, ment of DN, because effective disease-modifying or preventive therapies are not yet available. A vast array of pharmacologic agents such as nonsteroidal anti-inflammatory drugs (NSAIDs), antidepressants, analgesics, and antiepileptic drugs are used alone or in combination for symptomatic management. These drugs result in moderate effectiveness, potential side effects, and drug interactions. This article will provide a brief overview of the pathophysiology of DN and review pharmacologic agents used for symptomatic management, with a focus on pregabalin (Lyrical, Pfizer) and duloxetine (Gymbafa, Lilly), currently the only agents that are approved by FDA for the pain management of diabetic peripheral neuropathy. Further research is warranted to assess long-term efficacy of available therapies in the hopes of providing a standard of therapy.