Chapter 16 - Strategies for the prevention or reversal of neuropathy

Abstract

Peripheral somatic and autonomic neuropathy are major risk factors that predict future mortality in diabetes, and prevention and treatment of neuropathy are important in reducing these risk factors. Currently, there are no medications that have been proven to be effective in preventing or reversing diabetic neuropathy in randomized, blinded (masked) clinical trials. Interventions are most likely to be effective early in the course of disease. At the present time, the only interventions that may be effective in preventing or reversing diabetic neuropathy are improved glycemic control and a lifestyle improvement that includes a tailored diet and exercise program. The clinical trials that support improved glycemic control and lifestyle interventions in diabetic somatic polyneuropathy and diabetic autonomic neuropathy are discussed. The data supporting benfotiamine, alpha-lipoic acid, exercise, dietary, and other approaches are discussed. Current clinical research and future potential experimental therapies that may be effective in management of diabetic neuropathy are outlined.