Diabetic neuropathy: Current management and future treatments

The current approach to preventing diabetic neuropathy is to improve hyperglycemic control by means of intensive insulin therapy, sometimes facilitated by the use of an insulin pump. Pancreatic transplantation to achieve the same end is under investigation, but its main disadvantages are the need for continuous immunosuppression and the high rate of graft failure (currently 45 % over 2 years). At present, a number of drugs with different mechanisms of action are being tested for the prevention of neuropathy. They include aldose reductase inhibators; various neurotrophic factors, including nerve growth factor; Org 2766, an adrenocorticotropic hormone analogue that has been shown to promote neuronal survival after injury; and the gangliosides. Management of this common condition centers on relieving painful symptoms, preventing ulcers through proper foot care, and controlling diabetic diarrhea with drug therapy.