Diabetic Peripheral Neuropathy

Epidemiology, Diagnosis, and Pharmacotherapy

Zohaib Iqbal, Shazli Azmi, Rahul Yadav, Maryam Ferdousi, Mohit Kumar, Daniel J. Cuthbertson, Jonathan Lim, Rayaz Malik, Uazman Alam

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Purpose: Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. Methods: A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors’ expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN. Findings: DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration. Implications: Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.

Original languageEnglish
JournalClinical Therapeutics
DOIs
Publication statusAccepted/In press - 1 Jan 2018

Fingerprint

Diabetic Neuropathies
Peripheral Nervous System Diseases
Epidemiology
Drug Therapy
Neuralgia
Therapeutics
Morbidity
United States Food and Drug Administration
Diagnostic Errors
PubMed
Analgesics
Sleep
Biomarkers
Quality of Life
Databases
Guidelines

Keywords

  • diabetes
  • diagnosis
  • epidemiology
  • neuropathy
  • pharmacotherapy

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Iqbal, Z., Azmi, S., Yadav, R., Ferdousi, M., Kumar, M., Cuthbertson, D. J., ... Alam, U. (Accepted/In press). Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clinical Therapeutics. https://doi.org/10.1016/j.clinthera.2018.04.001

Diabetic Peripheral Neuropathy : Epidemiology, Diagnosis, and Pharmacotherapy. / Iqbal, Zohaib; Azmi, Shazli; Yadav, Rahul; Ferdousi, Maryam; Kumar, Mohit; Cuthbertson, Daniel J.; Lim, Jonathan; Malik, Rayaz; Alam, Uazman.

In: Clinical Therapeutics, 01.01.2018.

Research output: Contribution to journalArticle

Iqbal, Zohaib ; Azmi, Shazli ; Yadav, Rahul ; Ferdousi, Maryam ; Kumar, Mohit ; Cuthbertson, Daniel J. ; Lim, Jonathan ; Malik, Rayaz ; Alam, Uazman. / Diabetic Peripheral Neuropathy : Epidemiology, Diagnosis, and Pharmacotherapy. In: Clinical Therapeutics. 2018.
@article{e5da56ae924b4f12835a39fc9cc0120c,
title = "Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy",
abstract = "Purpose: Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. Methods: A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors’ expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN. Findings: DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration. Implications: Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.",
keywords = "diabetes, diagnosis, epidemiology, neuropathy, pharmacotherapy",
author = "Zohaib Iqbal and Shazli Azmi and Rahul Yadav and Maryam Ferdousi and Mohit Kumar and Cuthbertson, {Daniel J.} and Jonathan Lim and Rayaz Malik and Uazman Alam",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.clinthera.2018.04.001",
language = "English",
journal = "Clinical Therapeutics",
issn = "0149-2918",
publisher = "Excerpta Medica",

}

TY - JOUR

T1 - Diabetic Peripheral Neuropathy

T2 - Epidemiology, Diagnosis, and Pharmacotherapy

AU - Iqbal, Zohaib

AU - Azmi, Shazli

AU - Yadav, Rahul

AU - Ferdousi, Maryam

AU - Kumar, Mohit

AU - Cuthbertson, Daniel J.

AU - Lim, Jonathan

AU - Malik, Rayaz

AU - Alam, Uazman

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Purpose: Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. Methods: A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors’ expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN. Findings: DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration. Implications: Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.

AB - Purpose: Diabetic peripheral neuropathy (DPN) is the commonest cause of neuropathy worldwide, and its prevalence increases with the duration of diabetes. It affects approximately half of patients with diabetes. DPN is symmetric and predominantly sensory, starting distally and gradually spreading proximally in a glove-and-stocking distribution. It causes substantial morbidity and is associated with increased mortality. The unrelenting nature of pain in this condition can negatively affect a patient's sleep, mood, and functionality and result in a poor quality of life. The purpose of this review was to critically review the current literature on the diagnosis and treatment of DPN, with a focus on the treatment of neuropathic pain in DPN. Methods: A comprehensive literature review was undertaken, incorporating article searches in electronic databases (EMBASE, PubMed, OVID) and reference lists of relevant articles with the authors’ expertise in DPN. This review considers seminal and novel research in epidemiology; diagnosis, especially in relation to novel surrogate end points; and the treatment of neuropathic pain in DPN. We also consider potential new pharmacotherapies for painful DPN. Findings: DPN is often misdiagnosed and inadequately treated. Other than improving glycemic control, there is no licensed pathogenetic treatment for diabetic neuropathy. Management of painful DPN remains challenging due to difficulties in personalizing therapy and ascertaining the best dosing strategy, choice of initial pharmacotherapy, consideration of combination therapy, and deciding on defining treatment for poor analgesic responders. Duloxetine and pregabalin remain first-line therapy for neuropathic pain in DPN in all 5 of the major published guidelines by the American Association of Clinical Endocrinologists, American Academy of Neurology, European Federation of Neurological Societies, National Institute of Clinical Excellence (United Kingdom), and the American Diabetes Association, and their use has been approved by the US Food and Drug Administration. Implications: Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition.

KW - diabetes

KW - diagnosis

KW - epidemiology

KW - neuropathy

KW - pharmacotherapy

UR - http://www.scopus.com/inward/record.url?scp=85046135324&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85046135324&partnerID=8YFLogxK

U2 - 10.1016/j.clinthera.2018.04.001

DO - 10.1016/j.clinthera.2018.04.001

M3 - Article

JO - Clinical Therapeutics

JF - Clinical Therapeutics

SN - 0149-2918

ER -