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Diabetic neuropathy: what does the future hold? (published online 23/01/2020)

Diabetic neuropathy: what does the future hold? (published online 23/01/2020)

Brian C. Callaghan, Gary Gallagher, Vera Fridman, Eva L. Feldman

New treatments for diabetic neuropathy are needed since glycaemic control is not the complete answer. In this issue, Callaghan et al (https://doi.org/10.1007/s00125-020-05085-9) discuss recent evidence, which points to new metabolic risk factors for diabetic neuropathy, and novel disease-modifying strategies. Specifically, obesity is an important metabolic risk factor for neuropathy, and this may have treatment ramifications. Diet and exercise have emerged as promising interventions, but future studies are needed to determine their effects on neuropathy outcomes. In addition, dyslipidaemia and altered sphingolipid metabolism are potential mechanisms for nerve injury; it is suggested that a better understanding of these could provide hope for new targeted therapies. Regarding diagnostic testing, Callaghan et al state that the evaluation of neuropathy requires a good clinical history, neurological examination and a few simple blood tests. In their review, they also discuss painful diabetic neuropathy, outlining guidelines that propose that this condition should be treated with tricyclic antidepressants, serotonin-reuptake inhibitors and gabapentinoids. However, opioids should be avoided since data supporting long term opioid use for painful diabetic neuropathy are lacking and data supporting the downsides of these medications are mounting quickly. The authors conclude that there is a clear need for new medications and other interventions for the treatment of painful diabetic neuropathy.

The figure from this review is available as a downloadable slide.

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