Management Of Diabetic Peripheral Neuropathy Research Articles

Effectiveness of Duloxetine versus Other Therapeutic Modalities in Patients with Diabetic Neuropathic Pain: A Systematic Review and Meta-Analysis.

Objectives: Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus (DM) with symptoms like intense pain and impaired quality of life. This condition has no treatment; instead, the pain is managed with various antidepressants, including duloxetine. The aim of this study is to analyze the evidence on the efficacy of duloxetine in the management of DPN. Methods: A systematic search in different databases was conducted using the keywords "diabetic neuropathy", "duloxetine therapy", "neuropathic pain", and "Diabetes Mellitus". Finally, eight studies were included in this meta-analysis. Results: All articles comparing duloxetine at different doses vs. a placebo reported significant differences in favor of duloxetine on pain scales like 24 h Average Pain Severity (standardized mean difference [SMD] = -1.06, confidence interval [CI] = -1.09 to -1.03, and p < 0.00001) and BPI Severity (SMD = -0.70, CI = -0.72 to -0.68, and p < 0.00001), among others. A total of 75% of the meta-analyses of studies comparing duloxetine at different doses showed a tendency in favor of the 120 mg/d dose. There were significant differences in favor of duloxetine when compared to routine care on the Euro Quality of Life (SMD = -0.04, CI = -0.04 to -0.03, and p < 0.00001) and SF-36 Survey (SMD = -5.86, CI = -6.28 to -5.44, and p < 0.00001) scales. There were no significant differences on the visual analog scale (VAS) when comparing duloxetine and gabapentin. Conclusions: Duloxetine appears to be effective in the management of DPN in different pain, symptom improvement, and quality of life scales.

The efficacy and safety of electroacupuncture for diabetic peripheral neuropathy: A protocol for a systematic review and meta-analysis.

Diabetic peripheral neuropathy (DPN) is a chronic complication of diabetes mellitus, which is the most common neuropathy worldwide. Owing to the inadequacies of existing treatment methods, managing DPN remains a significant challenge. Studies suggest that electroacupuncture (EA) could potentially serve as a beneficial alternative treatment for this condition. Nevertheless, there is still inadequate proof of its therapeutic effectiveness and safety. As a result, the goal of this protocol is to methodically compile the data pertaining to the effectiveness and security of EA in the management of DPN. To find appropriate randomized controlled trials (RCTs), nine reliable databases in the English and Chinese languages will be examined. RevMan5.3 will be used to combine the retrieved data and perform meta-analyses. The methodological quality of the included RCTs will be evaluated using the Cochrane Risk of Bias Assessment 2.0 tool. The Grades of Recommendations, Assessment, Development, and Evaluation (GRADE) system will be utilized to evaluate the degree of strength and certainty of the evidence. We will also perform publication bias, sensitivity and subgroup analyses. This protocol describes the intended scope and approach for a forthcoming systematic review and meta-analysis that will inform therapeutic decision-making by offering current information on the efficacy and safety of EA in the treatment of DPN. The results of the study will help standardize strategies for EA in the treatment of DPN.

Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins

Expert consensus guidelines for community pharmacists in the management of diabetic peripheral neuropathy with a combination of neurotropic B vitamins

Advancing the understanding and management of diabetic peripheral neuropathy

Advancing the understanding and management of diabetic peripheral neuropathy

Glucagon-like peptide-1 receptor agonists for the management of diabetic peripheral neuropathy.

Diabetes mellitus is a prevalent chronic disease characterized by hyperglycemia. Diabetic peripheral neuropathy (DPN) is one of the complications of diabetes mellitus and is caused by neuron injury induced by hyperglycemic circumstances. The incidence of DPN varies among different countries and regions, ranging from nearly 20% to over 70%. Patients with DPN may encounter symmetric pain or discomfort of the extremes, leading to reduced quality of life and even amputation. The pharmacological management for painful DPN mainly includes antidepressants due to their analgesic effects. Nevertheless, effective therapies to impact the pathogenesis and progression of DPN are lacking. Glucagon-like peptide-1 receptor (GLP-1R) agonists show efficacy in controlling blood glucose and serve as a treatment modality for diabetes mellitus. In recent years, evidence has been proposed that GLP-1R agonists exert neuroprotective effects through modulating inflammation, oxidative stress, and mitochondrial dysfunction. On the other hand, clinical evidence on the potential of GLP-1R agonists for treating DPN is still controversial and limited. This narrative review summarizes the preclinical and clinical studies investigating the capacity of GLP-1R agonists as therapeutic agents for DPN.

Sahacharadi Yapan Basti a silver bullet in ayurvedic management of diabetic peripheral neuropathy- a case study

Introduction: Diabetic Peripheral Neuropathy (DPN) is the most common complications of Diabetes Mellitus (DM). It is a nerve damaging disorder mainly associated with Type-1 and Type-2 DM. These conditions are result from Diabetic Microvascular injury involving small blood vessels that supply nerves. Here we present a case study which was successfully managed with Ayurvedic medications and Panchakarma therapy. Material and Methods: A 64 years old Male patient suffering from DPN was managed with Panchakarma therapy and oral Ayurvedic medications. Bala-Ksheer Shalishashtik Pinda Sweda for 30 days Sahacharadi Yapan Basti were given total 3 sittings of Basti of 8 days with 10 days of resting period after every sitting. Oral Ayurvedic Medications like Suvarna Malini Vasant 125mg were administered once daily with Goghrita, Panchamrut Loha Guggulu 500mg thrice in a day etc. These oral medicines continued for 2 months. Result: By using Modified Neuropathy Disability Score and Grading for Neuropathy were assessed and it shows good improvement. Before treatment patient was suffered from severe peripheral neuropathy which was changed to mild neuropathy after 2 months’ treatment. Conclusion- Study result indicates that Panchakarma and Ayurvedic drugs may play a major role in the management of DPN.

Channeling of New Neuropsychiatric Drugs-Impact on Safety and Effectiveness Studies.

This study aimed to examine differential prescribing due to channeling and propensity score non-overlap over time in new versus established treatments for common neurological conditions. We conducted cross-sectional analyses on a national sample of US commercially insured adults using 2005-2019 data. We compared new users of recently approved versus established medications for management of diabetic peripheral neuropathy (pregabalin versus gabapentin), Parkinson disease psychosis (pimavanserin versus quetiapine), and epilepsy (brivaracetam versus levetiracetam). Within these drug pairs, we compared demographic, clinical, and healthcare utilization characteristics of recipients of each drug. In addition, we fit yearly propensity score models for each condition and assessed propensity score non-overlap over time. For all three drug pairs, users of the more recently approved medications more frequently had prior treatment (pregabalin = 73.9%, gabapentin = 38.7%; pimavanserin = 41.1%, quetiapine = 14.0%; brivaracetam = 93.4%, levetiracetam = 32.1%). Propensity score non-overlap and its resulting sample loss after trimming were the greatest in the first year that the more recently approved medication was available (diabetic peripheral neuropathy, 12.4% non-overlap; Parkinson disease psychosis, 6.1%; epilepsy, 43.2%) and subsequently improved. Newer neuropsychiatric therapies appear to be channeled to individuals with refractory disease or intolerance to other treatments, leading to potential confounding and biased comparative effectiveness and safety study findings when compared to established treatments. Propensity score non-overlap should be reported in comparative studies that include newer medications. When studies comparing newer and established treatments are critically needed as soon as new treatments enter the market, investigators should recognize the potential for channeling bias and implement methodological approaches like those demonstrated in this study to understand and improve this issue in such studies.

A Study on the Effects of Pregabalin and Amitriptyline in Treatment of Patients with Painful Diabetic Neuropathy

Objective: To compare the effect of Amitriptyline and Pregabalin in treatment of painful diabetic neuropathy. Material and Methods: The design of this study was Randomized Controlled Trial study design. This study was conducted in the Department of Medicine in, Holy Family Hospital, Rawalpindi and the duration of this study was Six months after the approval of synopsis i.e from 1st November 2019 to 1st May 2020. Approval from ethical committee of the hospital was taken. Written informed consent was taken from patients. Consent form is attached with this. Patients were randomly allocated into two groups by lottery method. The dose of Pregabalin was used as 50mg thrice daily for a period of six weeks and label as group-A and group B received amitriptyline as 25mg once daily before bedtime for a period of six weeks as prescribed by a senior consultant who was blind to object of the study. At the start and end of treatment pain was marked by patients on Visual Analogue Scale (VAS) and numerical score. It was noted on the Performa. Results: Total 100 patients were included according to the inclusion criteria of the study. The dose of Pregabalin was given in patients in group-A and group-B received amitriptyline. Mean age (years) in the study was 55.87+6.43 whereas there were 55 (55.0) male and 45 (45.0) female patients who were included in the study according to the inclusion criteria. In our study, frequency and percentage of effect (pain relief) among Pregabalin and Amitriptyline in treatment of painful diabetic neuropathy was 27 (54.0) and 11 (22.0) respectively which was statistically significant (p-value 0.001). Practical Implication: In this study Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of amitriptyline and Pregabalin in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Conclusion: The study concluded that Pregabalin is more responsible for pain relief than Amitriptyline in treatment of painful diabetic neuropathy. Further studies at multiple studies must be conduct in future for determining the efficacy of Pregabalin and amitriptyline in diabetic neuropathy in order to formulate guidelines for management of diabetic peripheral neuropathy. Keywords: Amitriptyline, Pregabalin, Neuropathy, Pain Relief, Diabetic Sensorimotor Polyneuropathy, Prevalence.

Are herbal medicines alone or in combination for diabetic peripheral neuropathy more effective than methylcobalamin alone? A systematic review and meta-analysis

Background and purposeIn Asian countries, herbal medicines have been used to treat diabetic peripheral neuropathy (DPN) as an adjunctive therapy. This review aims to assess the effectiveness and safety of herbal medicines for the treatment of DPN. MethodsA literature search was conducted on PubMed, Embase, CENTRAL, Scopus, CINAHL, CNKI, DBPIA, and OASIS for randomized controlled trials that evaluated the effects of herbal medicines on DPN. The oral methylcobalamin administered group was selected as the control. The primary outcome measure was nerve conduction velocity (NCV), and the secondary outcome measure was the total efficacy rate (TER). The methodological quality of the included studies was assessed using the Cochrane risk of bias tool. A meta-analysis was conducted using Review Manager 5.4.1 software. ResultsSeventy-two RCTs with a total of 6260 patients were included. The meta-analysis showed that herbal medicine and co-administration of herbal medicine and methylcobalamin (CHM) treatment for DPN significantly increased the sensory nerve conduction velocity (SNCV) and motor nerve conduction velocity (MNCV) of the median and common peroneal nerves than methylcobalamin treatment alone. Herbal medicine and CHM treatment for DPN also significantly improved the TER compared to the control group. Herbal medicine and CHM treatment was found to be relatively safe. ConclusionOur study suggests that herbal medicine and CHM might be more effective than methylcobalamin alone in the management of DPN. Further rigorous studies should be conducted to make more definite conclusions.

Myricetin Improves Impaired Nerve Functions in Experimental Diabetic Rats.

Diabetic peripheral neuropathy (DPN) is considered as one of the most important complications of diabetes mellitus. At present, effective treatments that might improve the damaged neurological function in DPN are sorely needed. As myricetin has been proved to possess excellent neuroprotective and antioxidant effects, it might have therapeutic potential for DPN. Therefore, the purpose of our study was to detect the potential beneficial effect of myricetin on DPN. A single dose of 50 mg/kg of streptozotocin was applied in rats for the establishment of diabetic models. Different doses of myricetin (0.5 mg/kg/day, 1.0 mg/kg/day, and 2.0 mg/kg/day) were intraperitoneally injected for 2 weeks from the 21st day after streptozotocin injection. After the final myricetin injection, behavioral, electrophysiological, biochemical, and protein analyses were performed. In the present study, myricetin significantly ameliorated diabetes-induced impairment in sensation, nerve conduction velocities, and nerve blood flow. In addition, myricetin significantly reduced the generation of advanced glycation end-products (AGEs) and reactive oxygen species (ROS), and elevated Na+, K+-ATPase activity and antioxidant activities in nerves in diabetic animals. Additional studies revealed that myricetin significantly raised the hydrogen sulfide (H2S) levels, and elevated the expression level of heme oxygenase-1 (HO-1) as well as nuclear factor-E2-related factor-2 (Nrf2) in diabetic rats. In addition, myricetin has the capability of decreasing plasma glucose under diabetic conditions. The findings in our present study collectively indicated that myricetin could restore the impaired motor and sensory functions under diabetic conditions. The Nrf2-dependent antioxidant action and the capability of decreasing plasma glucose might be the underlying mechanisms for the beneficial effect of myricetin on impaired neural functions. Our study showed the therapeutic potential of myricetin in the management of DPN.

The Emerging Role of Continuous Glucose Monitoring in the Management of Diabetic Peripheral Neuropathy: A Narrative Review.

The aim of this narrative review is to present data on the role of continuous glucose monitoring (CGM) in the management of peripheral diabetic neuropathy (DPN) among individuals with type 1 and type 2 diabetes mellitus. Adequate glycaemic control is crucial to prevent the development or progression of DPN. CGM systems are valuable tools for improving glycaemic control and reducing glycaemic variability (GV). Chronic hyperglycaemia is known to be a risk factor for the development of diabetic microvascular complications, including DPN. In addition, there is now evidence that GV, evaluated by mean amplitude of glycaemic excursions, may be a novel factor in the pathogenesis of diabetic complications. Increased GV appears to be an independent risk factor for DPN and correlates with painful neuropathy. Similarly, time-in-range correlates positively with peripheral nerve function and negatively with sudomotor dysfunction. However, relevant studies are rather limited in scope, and the vast majority are cross-sectional and use different methodologies for the assessment of DPN. Therefore, the causal relationship between CGM-derived data and the development of DPN cannot be firmly established at the present time. It also remains to be elucidated whether CGM measures can be considered the new therapeutic targets for DPN management.

Effects of neurodynamic exercises on the management of diabetic peripheral neuropathy of the upper limb: a case series

IntroductionThis study has been designed to find out the effectiveness of neurodynamic exercises in patients with diabetes mellitus having peripheral neuropathy in upper limb.MethodsThis was a case series. Total 40 patients were selected in this study who had diabetes mellitus type II with peripheral neuropathy pain. Consecutive sampling technique was used. Standard Neurodynamic sliders’ techniques were applied for Radial, Ulnar and Median nerves in appropriate position by qualified physical therapist for 10 sec with 2 sec rest and 10 repetitions. TENS (80 Hz and 150µ sec) was applied for 20 minutes. Neuropathic pain questionnaire DN 4 was used to collect the data. Pretest and posttest value were calculated using this questionnaire. Paired sample T test was used to compare the pretest and posttest values.ResultsThere were 31 females and 8 males with peripheral neuropathy in this study. The mean age of the patients was 51.22 ± 6.712 years. The mean value of total pretest was 6.42 ± 1.152 and the mean of total posttest value was 3.68 ± 1.095.ConclusionNeurodynamic exercises were effective in managing diabetic peripheral neuropathy pain. Neurodynamics techniques for Peripheral Nerve can reduce the diabetes associated peripheral neuropathy symptoms in upper limb.

Integrated Management of Diabetic Peripheral Neuropathy with Naturopathy, Yoga And Diet Control: A Case Report

oday, among metabolic disorders, diabetes can be considered the most common, increasing, serious, and costly public health problem in the World. Among them, microangiopathies leading to nephropathies, optic nerve damage associated with retinopathies, and diabetic peripheral neuropathy (DPN) associated with pain, tingling, or numbness, loss of feeling in the hands, arms, feet, and legs can occur primarily due to uncontrolled diabetes levels. The main reason to visit in a primary care setting is chronic pain. Moreover, it is difficult to treat because of its severity, chronicity, and resistance to simple analgesics. Non-pharmacological approaches and non-conventional treatments such as naturopathy, yoga, and diet modification are used to relieve pain, improve well-being, and treat acute, chronic, and degenerative conditions of peripheral neuropathy associated with Type 2 Diabetes Mellitus.

Ammonium Glycyrrhizinate Prevents Apoptosis and Mitochondrial Dysfunction Induced by High Glucose in SH-SY5Y Cell Line and Counteracts Neuropathic Pain in Streptozotocin-Induced Diabetic Mice.

Glycyrrhiza glabra, commonly known as liquorice, contains several bioactive compounds such as flavonoids, sterols, triterpene, and saponins; among which, glycyrrhizic acid, an oleanane-type saponin, is the most abundant component in liquorice root. Diabetic peripheral neuropathy is one of the major complications of diabetes mellitus, leading to painful condition as neuropathic pain. The pathogenetic mechanism of diabetic peripheral neuropathy is very complex, and its understanding could lead to a more suitable therapeutic strategy. In this work, we analyzed the effects of ammonium glycyrrhizinate, a derivate salt of glycyrrhizic acid, on an in vitro system, neuroblastoma cells line SH-SY5Y, and we observed that ammonium glycyrrhizinate was able to prevent cytotoxic effect and mitochondrial fragmentation after high-glucose administration. In an in vivo experiment, we found that a short-repeated treatment with ammonium glycyrrhizinate was able to attenuate neuropathic hyperalgesia in streptozotocin-induced diabetic mice. In conclusion, our results showed that ammonium glycyrrhizinate could ameliorate diabetic peripheral neuropathy, counteracting both in vitro and in vivo effects induced by high glucose, and might represent a complementary medicine for the clinical management of diabetic peripheral neuropathy.

EFFICACY OF COMBINATION OF VITAMIN B1, B6 AND B12 IN MANAGEMENT OF DIABETIC PERIPHERAL NEUROPATHY

Aim: To determine the efcacy of combination of vitamin B1, B6 and B12 in the management of diabetic peripheral neuropathy. Methods: Patients of diabetes mellitus with diabetic peripheral neuropathy were selected from Department of Medicine, Govt. Medical College and Hospital, Bettiah, W. Champaran, Bihar and study done at Pharmacology Department of GMC, Bettiah, W. Champaran, Bihar. The duration of study was six months from March 2019 to August 2019. Patients were prescribed Tab Neurobion (vitamin B1 100mg, vitamin B6 100mg, Vitamin B12 200mcg) twice a day for a period of 4 weeks (28 days). Follow up visit was scheduled on 28th day of the initial visit. Efcacy was judged by documenting improvement in pain of at least 2 points from the baseline as assessed by numeric pain rating scale. Mean age of the patients was observed Results: 46.7±8.6 years. Out of 310 cases, 177 patients (57.0%) were male and remaining 133 patients (43.0%) were female. Duration of diabetes as follows: 83 patients (26.8%) had duration of 0-10 year, 139 patients (44.8%) had 11-20 year, 77 patients (24.8%) had 21-30 year and 11 patients (3.6%) had &gt;30 years of duration. Combination of vitamin B1, B6 and B12 in the management of diabetic peripheral neuropathy was found to be efcacious in 271 patients (87.4%). Treatment with combination of vitamin B1, B6 and B12 Conclusion: appeared to improve pain relief among patients with diabetic peripheral neuropathy.

Management of Diabetic Peripheral Neuropathy Using Ayurvedic Protocol: A Case Report

Management of Diabetic Peripheral Neuropathy Using Ayurvedic Protocol: A Case Report

Aloperine attenuates high glucose-induced oxidative injury in Schwann cells via activation of NRF2/HO-1 pathway

Purpose: To determine the involvement of nuclear factor erythroid 2-related factor 2 (NRF2) and heme oxygenase-1 (HO-1) in the action of aloperine on Schwann cell injury caused by high glucose (HG).Methods: Cell viability was determined using MTT assay while the release of lactate dehydrogenase (LDH) was determined by biochemical assay. Apoptosis was assessed using flow cytometry, while the levels of malondialdehyde (MDA) were determined by Annexin V-FIT staining. Glutathione Stransferase (GST), glutathione peroxidase (GPX), and reactive oxygen species (ROS) were determined using enzyme-linked immunosorbent assay.Results: Treatment with HG suppressed RSC96 cell viability and increased LDH release, while aloperine reversed these results (p &lt; 0.05). Apoptosis of RSC96 cells was induced by HG stimulation, but was abolished by aloperine. The levels of ROS, MDA, and GST were enhanced in cells followingtreatment with HG, but was reversed by aloperine (p &lt; 0.05). The decreased level of GPX caused by HG in RSC96 cells was elevated by aloperine. Moreover, aloperine upregulated NRF2 and HO-1 in RSC96 cells treated with HG (p &lt; 0.05).Conclusion: Aloperine attenuates HG-induced oxidative injury in Schwann cells via activation of NRF2/HO-1 pathway, suggesting its potential as a potent drug for the management of diabetic peripheral neuropathy.&#x0D; Keywords: Aloperine, Schwann cells, High glucose, Oxidative stress, NRF2, HO-1

Insulin Treatment Attenuates Small Nerve Fiber Damage in Rat Model of Type 2 Diabetes.

Introduction Current clinical guidelines for management of diabetic peripheral neuropathy (DPN) emphasize good glycemic control. However, this has limited effect on prevention of DPN in type 2 diabetic (T2D) patients. This study investigates the effect of insulin treatment on development of DPN in a rat model of T2D to assess the underlying causes leading to DPN. Methods Twelve-week-old male Sprague-Dawley rats were allocated to a normal chow diet or a 45% kcal high-fat diet. After eight weeks, the high-fat fed animals received a mild dose of streptozotocin to induce hyperglycemia. Four weeks after diabetes induction, the diabetic animals were allocated into three treatment groups receiving either no insulin or insulin-releasing implants in a high or low dose. During the 12-week treatment period, blood glucose and body weight were monitored weekly, whereas Hargreaves' test was performed four, eight, and 12 weeks after treatment initiation. At study termination, several blood parameters, body composition, and neuropathy endpoints were assessed. Results Insulin treatment lowered blood glucose in a dose-dependent manner. In addition, both doses of insulin lowered lipids and increased body fat percentage. High-dose insulin treatment attenuated small nerve fiber damage assessed by Hargreaves' test and intraepidermal nerve fiber density compared to untreated diabetes and low-dose insulin; however, neuropathy was not completely prevented by tight glycemic control. Linear regression analysis revealed that glycemic status, circulating lipids, and sciatic nerve sorbitol level were all negatively associated with the small nerve fiber damage observed. Conclusion In summary, our data suggest that high-dose insulin treatment attenuates small nerve fiber damage. Furthermore, data also indicate that both poor glycemic control and dyslipidemia are associated with disease progression. Consequently, this rat model of T2D seems to fit well with progression of DPN in humans and could be a relevant preclinical model to use in relation to research investigating treatment opportunities for DPN.

Depression Symptoms in Patients with Diabetic Peripheral Neuropathy.

AIMThe study aimed to investigate the possible relationship between diabetic peripheral neuropathy (DPN) and the development of depressive symptoms in patients with type 2 diabetes mellitus (T2D).METHODSA comparative non-experimental study was conducted. Ninety-five T2D individuals aged 65 years and more were recruited. The sample was divided into two groups: 50 participants with T2D and without DPN and 45 participants with T2D and DPN. The Patient Health Questionnaire 9 (PHQ-9) was used to collect information about low mood and depression symptoms in the subjects recruited.RESULTSParticipants with DPN recorded higher scores on PHQ-9 than those with T2D only. The mean PHQ-9 score for the DPN group (6.09) was significantly higher than that for the T2D only group (2.24) (p < 0.001). Participants with DPN were more likely to have mild to moderate or moderately severe low mood and depression symptoms than T2D only participants who exhibited minimal to no low mood and depressive symptoms.CONCLUSIONSThe association between DPN and depression is confirmed by this study, with significant depressive symptoms found in patients with neuropathy when compared to diabetes patients with no neurological complications. It is therefore important that discomfort and emotional problems caused by DPN should be taken seriously and addressed closely in the management of DPN in order to prevent depression. Also, a change in screening practices to identify patients with diabetes and depressive symptoms is required.

127-OR: Pharmacologic Management of Diabetic Peripheral Neuropathy

Approximately half of all people with diabetes develop diabetic peripheral neuropathy (DPN) and half experience pain. Guidelines recommend pregabalin, gabapentin, and duloxetine (a selective norepinephrine and serotonin reuptake inhibitor [SNRI]) due to their demonstrated efficacy and safety. Topical analgesics, tricyclic anti-depressants (TCA), and anti-convulsants may also be used. Opioids are discouraged due to lack of effectiveness, risk of addiction, and safety concerns. To promote safe evidence-based pain management, we examined pain medication use by adults diagnosed with DPN between 2002-2019 in an integrated healthcare system across 5 states. We identified 13,815 adults with newly diagnosed DPN; mean age 66 (SD, 13) years, 42% female, 93% white, 29% insulin-treated. Overall, 56% received a pain medication from DPN diagnosis (1 month prior or continued from baseline) to 2 years later. Limiting to treatment pathways observed in ≥1% of cases, opioids were the most used 1st line medication, followed by gabapentin and others (Figure). Opioids and gabapentin were also the most prevalent 2nd line drugs. High rates of opioid use by patients with DPN, a life-long pain syndrome, are concerning particularly as safer effective treatment options are available. Further research is needed to identify drivers of opioid use and barriers to evidence-based alternatives, and develop interventions to improve DPN management in clinical practice. Disclosure J. Fan: None. M.M. Jeffery: None. W. Hooten: None. N. Shah: None. R.G. McCoy: None. Funding National Institutes of Health (K23DK114497)