TheadvancementofmedicationresearchofdiabeticneuropathyBackgroundWhatarediabeticneuropathies?Diabeticneuropathiesareafamilyofnervedisorderscausedbydiabetes.Peoplewithdiabetescan,overtime,developnervedamagethroughoutthebody.Somepeoplewithnervedamagehavenosymptoms.Othersmayhavesymptomssuchaspain,tingling,ornumbness-lossoffeeling-inthehands,arms,feet,andlegs.Nerveproblemscanoccurineveryorgansystem,includingthedigestivetract,heart,andsexorgans.

/dm/pubs/neuropathies//PeripheralneuropathyAutonomicneuropathyProximalneuropathythemostcommontypeofdiabeticneuropathy,causespainorlossoffeelinginthetoes,feet,legs,hands,andarms.causespaininthethighs,hips,orbuttocksandleadstoweaknessinthelegs.causeschangesindigestion,bowelandbladderfunction,sexualresponse,andperspiration.Whatarethetypesofdiabeticneuropathy?Focalneuropathyresultsinthesuddenweaknessofonenerveoragroupofnerves,causingmuscleweaknessorpain.Anynerveinthebodycanbeaffected.DecreasebloodglucoselevelsPainReliefMetabolicdisorderrectificationMicrocirculationimprovementOxidativestressantagonismClinicalTherapyHowarediabeticneuropathiestreated?PainRelief(DuloxetineandTapentadol)Metabolicdisorderrectificationandanti-oxidant(Actoveginandα-lipoicacid)

THERAPYADVANCEMENT0102DocumentreviewAdjunctivetherapy(TheHyperbaricOxygenTherapyandNeuragenPN)03PainReliefOthertypesofantidepressants

Anticonvulsants

Opioidsandopioid-likedrugs

Tricyclicantidepressantscontrolled-releaseoxycodoneandtramadolpregabalin,gabapentin,carbamazepine,andlamotrigineamitriptyline,imipramine,anddesipramineduloxetine,venlafaxine,bupropion,paroxetine,andcitalopramDocumentreview/NewsEvents/Newsroom/PressAnnouncements/2004/ucm108349.htm

DuloxetineandpregabalinareapprovedbytheU.S.FoodandDrugAdministrationspecificallyfortreatingpainfuldiabeticperipheralneuropathy.

FDADuloxetineeffectiveintreatmentofdiabeticperipheralneuropathicpainaselectiveserotoninandnoradrenalinereuptakeinhibitorAdversereaction:nausea,somnolence,anorexia,anddysuriaDuloxetineversusplacebointhetreatmentofpatientswithdiabeticneuropathicpaininChinaChinMedJ,2010;123(22):3184-3192ConclusionAlthoughtheprimaryendpointofthestudywasnotachieved,theoverallpatternofobservedresponsessuggestsefficacyofduloxetine60mgand,particularly,120mgoncedailyinthetreatmentofChinesepatientswithDPNP.Thesafetyprofileforduloxetineissimilartothatreportedinotherglobaltrials.

Medicationadherenceandhealthcarecostsamongpatientswithdiabeticperipheralneuropathicpaininitiatingduloxetineversuspregabalin.

CurrMedResOpin,2011,27(4):785-92.MPRProportionofpatientswithMPR?≥?0.8

Totalhealthcarecostsduloxetinepregabalin

Tapentadol

—Centraloralanalgecis

Tapentadolimmediate-releasetablets

areapprovedbytheU.S.FoodandDrugAdministrationspecificallyfortreatingmoderateandseverepaininadult.

QilupharmarceuticalAffairs,2009,28(1):19.A.ExcitedopioidreceptorB.InhibitonofnorepinephrinereuptakeSafetyandefficacyoftapentadolERinpatientswithpainfuldiabeticperipheralneuropathy:resultsofarandomized-withdrawal,placebo-controlledtrial.

CONCLUSIONS:

Comparedwithplacebo,tapentadolER100-250?mgbidprovidedastatisticallysignificantdifferenceinthemaintenanceofaclinicallyimportantimprovementinpain1,2andwaswell-toleratedbypatientswithpainfulDPN.

CurrMedResOpin,2011,27(1):151-62.PainRelief(DuloxetineandTapentadol)Metabolicdisorderrectificationandanti-oxidant(Actoveginandα-lipoicacid)

THERAPYADVANCEMENT0102DocumentreviewAdjunctivetherapy(TheHyperbaricOxygenTherapyandNeuragenPN)03Actovegin

--DeproteinizedCalfbloodPreviouslyusedfortreatmentofcerebralvascularanddegenerativedisorders.13

oxygenabsorption

oxygenutilization

cellularenergymetabolism

improvenerveconductionvelocity,allodynia2

exertsinsulin-likeactivity

stimulationofglucosetransportpyruvatedehydrogenase

glucoseoxidationTreatmentofSymptomaticPolyneuropathy

WithActovegininType2DiabeticPatientsCONCLUSIONS

Theresultsofthismulticenter,randomized,controlledclinicaltrialshowthattreatmentofsymptomaticDPNwithintravenousinfusionsofactovegin(2,000mg)oncedailyfor20daysfollowedbyoraladministration(1,800mg/day)for140daysimprovesneuropathicsymptomsasscoredbytheTSS,VPTonbothfeet,thesensorynervefunctioncomponentoftheNIS-LL,andqualityoflifeasevidencedbythementalhealthdomainoftheSF-36.DiabetesCare,2009,32:1479–1484.α-lipoicacid(ALA)

--

Powerfulantioxidants

TheapplicationofALAtreatmentofDNabroadformorethan30years.IntravenousALAistheonlyrandomizedcontrolledtrialsandbyanumberofmeta-analysisconfirmedEtiologyoftreatmenteffect.Efficacyandsafetyofhigh-doseα-lipoicacidinthetreatmentofdiabeticpolyneuropathyCONCLUSIONSOraltreatmentwithhigh-doseα-lipoicacidfor12weeksmayimprovesymptomsinpatientswithdiabeticpolyneuropathy.Doseof600mgthricedailyfor2weekshasmarkedeffectswithareasonablesafety.ZhonghuaYiXueZaZhi,2010,90(35):2473-6.PainRelief(DuloxetineandTapentadol)Metabolicdisorderrectificationandanti-oxidant(Actoveginandα-lipoicacid)

THERAPYADVANCEMENT0102DocumentreviewAdjunctive