PATHOPHYSIOLOGY AND TREATMENT OF PAINFUL DIABETIC NEUROPATHY OF THE LOWER-EXTREMITY

Background. Symptomatic peripheral neuropathy is the most common compl ication of diabetes mellitus, affecting up to 62% of Americans with di abetes. Methods. We reviewed the literature using the National Library of Medicine's MEDLINE search service. In total, we reviewed 54 articl es. Results. Hyperglycemia leads to increased activity in the polyol p athway in nerve cells; this ultimately results in abnormal nerve funct ion. Numerous pharmacologic agents have been used to treat symptomatic peripheral neuropathy, but all of these drugs can be associated with adverse side effects. Recent work has indicated that subsensory electr ical stimulation may be preferred to pharmacotherapy, since it is equa lly effective and has a more favorable safety profile. Conclusion. Alt hough the pathophysiology of diabetic neuropathy is well understood, t reatment of the symptoms associated with this condition can be challen ging. Additional research is needed to reveal a safe and effective tre atment for this debilitating sequela of diabetes mellitus.