Treatment Of Diabetic Neuropathy Research Articles

Effect of Lupeol on the Expression of Neuro Inflammatory Signalling Molecules in Brain Tissues of High Fat Diet and Sucrose Fed Type-2 Diabetic Rats

Lupeol has anti- inflammatory, antimicrobial, anti-protozoal, anti-proliferative, anti-invasion, anti-angiogenic and cholesterol-lowering properties. However, the mechanisms underlying the effect of lupeol on neuroinflammatory signalling molecules have not yet been identified. The study was designed to study the effect of lupeol on the expression of inflammatory signalling molecules in brain tissue of high-fat diet and sucrose-fed type-2 diabetic rats. Adult male albino rats of Wistar 150–180 days old with 180–200 g body weight (b.wt) were divided into four groups of six rats each. Group I: Control (vehicle-treated): Group II: High fat diet-induced type-2 diabetic rats; Group III: Type-2 diabetic rats treated with lupeol (25 mg/kg b.wt/day) orally for 30 days and Group IV: Type-2 diabetic rats treated with metformin (50 mg/kg, b.wt/day orally for 30 days. After 30 days of treatment, the animals were anaesthetized, and brain tissue was dissected and used for the assessment of mRNA expression analysis. Type-2 diabetic animals showed a significant increase (p<0.05) in TNF-α and IL-6 mRNA levels in brain tissue in high-fat diet-induced type-2 diabetic animals. However, lupeol treatment, effectively reduced (p<0.05) the neuroinflammatory signaling molecules (TNF- α and IL-6 mRNA) showing that lupeol has significant role over the control of neuroinflammatory signaling. Our present findings clearly show that lupeol has a significant role in reducing neuroinflammation via the downregulation of TNF-α and IL-6 in brain tissues and hence, lupeol can be a potential natural drug for the treatment of diabetic neuropathy.

Efficacy of a Tailored COMET Protocol Combined with Medication on Vibratory Perception and SkinConductance in Diabetic Neuropathy- A Protocol for Randomized Controlled Trial

This research attempts to evaluate the effectiveness of a customized COMET protocol in conjunction with medicine for the treatment of diabetic neuropathy, with vibratory perception and skin conductance being the main focus. Participants will be allocated to either the intervention group, which will get the customized COMET protocol and medicine, or the control group, which will receive standard medication alone, in a randomized controlled trial. Validated measurement instruments will be used in the trial to evaluate variations in skin conductance and vibratory perception both at baseline and during the course of the investigation. Strict adherence to ethical rules will guarantee the safety and well-being of participants. This study intends to provide important insights into the holistic management of diabetic neuropathy by examining the effects of the customized COMET protocol in conjunction with medication on vibratory perception and skin conductance. This could result in better treatment plans and an improvement in the quality of life for those who are affected. CTRI Reference Number CTRI/2023/07/055366,https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=89691&EncHid=88073.73654&modid=1&compid=19,20/07/2023

Painful forms of diabetic neuropathy

Diabetic neuropathy is a frequent and severe degenerative complication of diabetes. The diagnosis is easily performed in painful symptomatic patients. Sensitivity disorders responsible for numbness, tingling, and loss of feeling are part and parcel of diabetic foot syndrome and require investigation in view of preventing trophic ulcers. To date, there exists no specific treatment for diabetic neuropathy possibly preventable by careful control of metabolic disorder. Effective management of diabetic patients would make it possible to limit the dramatic consequences of diabetic neuropathy while at the same time acting on other complications.

Clinical effects of combined use of carbamazepine and amitriptyline in the treatment of diabetic neuropathy with concurrent diabetic foot

Objective This study aims to analyze the clinical effects of combining carbamazepine and amitriptyline in the treatment of diabetic neuropathy with concurrent diabetic foot. Methods A total of 120 diabetic neuropathy patients treated at our hospital from June 2022 to November 2023 were included in the study. Patients meeting the inclusion criteria were registered, and their basic data were collected. The patients were randomly divided into two groups: the control group treated with amitriptyline and the study group treated with a combination of carbamazepine and amitriptyline. Results The study group demonstrated significantly better clinical efficacy compared to the control group (p < 0.05). There were no significant differences in psychological status and pain perception before treatment between the two groups (p > 0.05). However, post-treatment, the study group showed improved psychological status, reduced pain perception, and overall better quality of life in both physiological and psychological dimensions compared to the control group (p < 0.05). Conclusion The combined use of carbamazepine and amitriptyline in the treatment of diabetic neuropathy with concurrent diabetic foot yields positive clinical outcomes. It effectively alleviates symptoms, improves psychological well-being, reduces pain sensation, and enhances overall quality of life. These findings can guide physicians in adopting a more evidence-based treatment approach and provide patients with more effective individualized treatment strategies.

Early Detection of Diabetic Peripheral Neuropathy in Diabetic Patients: A Cross-Sectional Study.

Diabetic Peripheral Neuropathy (DPN) is a chronic complication in Type 2 Diabetes Mellitus (T2DM) patients and is characterized by paresthesia, pain, and hypoesthesia of the extremities. The Diabetic Neuropathy Symptom-Score (DNS) is a quick, inexpensive, and easy-to-perform tool to detect DPN in clinical practice. Biochemical markers like Nitric Oxide (NO) and Vascular Endothelial Growth Factor (VEGF) play a role in the early detection of DPN. This study aims to investigate the relationship between risk factors and these biomarkers. So, it is expected to improve the prevention and treatment of diabetic neuropathy more effectively. A cross-sectional method was used for this study. The sample size was 85 patients with T2DM who visited several primary healthcare in Medan, selected by consecutive sampling method based on eligibility criteria. Data collected included DNS, assessment of NO, VEGF, Glycated Hemoglobin (HbA1C), plasma blood glucose (PBG), and lipid profile. The collected data were analyzed using an independent T-test. The results showed that most T2DM patients, namely 73 people (85.9%), experienced DPN. From the bivariate analysis results, the risk factors associated with the prevalence of DPN in T2DM patients were found to be increased levels of total cholesterol, HbA1c, NO, and VEGF (p < 0.05). Meanwhile, blood pressure, fasting BGL, HDL-C, LDL-C, and triglycerides were not related to the occurrence of DPN in this study (p> 0.05). DNS can be used as a quick and easy initial screening tool implemented in clinical practice for screening DPN. Diabetic patients with DPN tend to have lower NO and increased VEGF; besides, NO levels are also associated with the progression of DPN. Furthermore, education, blood sugar control, and physical exercise, especially leg exercises, can prevent progressive DPN.

Development and Evaluation of Polyherbal Gel for Treatment of Diabetic Neuropathy

Diabetic neuropathy is a prevalent and painful issue of diabetes mellitus, impacting a large number of people with both type 1 and 2 diabetes. Herbal formulations are found to be effective and have fewer side effects. The study aimed to create a topical polyherbal gel using ethanolic extracts and to evaluate polyherbal gel. Ethanolic extract of Curcuma longa rhizomes and Gingko biloba leaves were obtained and used to prepare different formulations of polyherbal gels using Carbopol 940 and other excipients. The developed compositions were assessed using a range of gel evaluation standards, including physical examination pH, viscosity measurement, spreadability. The in-vitro permeation study is derived from the Franz diffusion. The evaluation shows ideal results for polyherbal gel. The pH of the polyherbal gel was observed to be between 6.22 and 6.51, which is considered suitable for topical application. The polyherbal gel formulations showed ideal viscosity range and spreadability. Among the four formulations, the PG3 formulation was found to be stable.

Technological Trends Involving Probiotics in the Treatment of Diabetic Neuropathy: A Patent Review (2009-2022).

Diabetic neuropathy (DN) causes neuropathic pain, and current treatments are unsatisfactory. Recently studies have demonstrated an assertive correlation between gut microbiota and pain modulation. Considering the emerging search for new therapies for the control of DN and the growing commercial interest in the probiotics market, this study aimed to provide patents on the use of probiotics in the control of DN. This is a patent prospection performed in the Espacenet Patent database, using the association of keywords and IPC related to probiotics in medical preparations and foods, from 2009 to December 2022. Results have shown that in 2020, there was a boom in patent filing in the area. Asian countries accounted for more than 50% of all 48 inventions (n = 48), with Japan as the only applicant in 2021. Products being developed in recent years point to effects that may represent an advancement in DN treatment, such as reduced concentration of pro-inflammatory mediators, metabolites and neurotransmitters release, and hypoglycemic potential. All effects were more related to the Lactobacillus and Bifidobacterium genera, associated with more than one property mentioned. The mechanisms attributed to the microorganisms suggest the therapeutic potential of probiotics in the non-pharmacological treatment of pain. New applications for probiotics have resulted from great research interest by academia, but also reflect commercial interests despite the paucity of clinical trials. Thus, the present work supports the evolution of research to explore the benefits of probiotics and their clinical use in DN.

DDD-028: A potent, neuroprotective, non-opioid compound for the treatment of diabetic neuropathy

Diabetic neuropathy (DN) is a painful, chronic ailment that affects a large segment of diabetic population worldwide. Current medications such as pregabalin or duloxetine treat only the pain symptom associated with DN, but not the underlying nerve damage. DDD-028 (1) is a small molecule that displays potent pain-relieving activity in streptozotocin (STZ)-induced rodent model of DN. Combined with other studies indicating that DDD-028 suppresses astrogliosis and nerve damage induced by the anti-cancer drug, paclitaxel, the present study suggests that DDD-028 would be useful as a disease modifying therapeutic in the treatment of DN. The 3-dimensional structure of DDD-028 was confirmed by single crystal X-ray crystallography.

Physicians’ Perception and Practice of Prescribing Vitamin B Combination versus Antiepileptic Drugs for Diabetic Neuropathy: Content Validity, Reliability and Pilot Study

Background: Diabetic neuropathy (DN) is the most common complication of diabetes mellitus causing increased morbidity and mortality. Although international guidelines did not include vitamins and dietary supplements in any line of management, these agents were prescribed by a significant number of physicians either as preventive or treatment of DN. This study aimed to develop a validated questionnaire that examines the physicians’ perception and practice towards prescribing vitamins or dietary supplements for DN treatment.&#x0D; Method: The questionnaire was developed upon literature review via PubMed, Medline, Web of Science, Scopus, and Google Scholar. The questionnaire was revised upon experts’ views and opinions. The constructed questionnaire was validated by the means of content validity and internal consistency. Finally, the developed questionnaire was piloted in a small representative sample of the original future aimed research target population, to test its applicability and feasibility.&#x0D; Results: A total of 19 items questionnaire were developed in two domains (perception and practice). Content validity analysis results met a satisfactory level, in which the S-CVI/UA value was 0.84 and 0.89 for clarity and relevance respectively. The questionnaire also showed good reliability, in which the Cronbach’s alphas was 0.824.&#x0D; Conclusion: This study showed the ability to construct a questionnaire with good levels of content validity and reliability that can cover different aspects of the current state of perception and practice among physicians regarding the management of DN.

Chemoproteomic target deconvolution reveals Histone Deacetylases as targets of (R)-lipoic acid

Lipoic acid is an essential enzyme cofactor in central metabolic pathways. Due to its claimed antioxidant properties, racemic (R/S)-lipoic acid is used as a food supplement but is also investigated as a pharmaceutical in over 180 clinical trials covering a broad range of diseases. Moreover, (R/S)-lipoic acid is an approved drug for the treatment of diabetic neuropathy. However, its mechanism of action remains elusive. Here, we performed chemoproteomics-aided target deconvolution of lipoic acid and its active close analog lipoamide. We find that histone deacetylases HDAC1, HDAC2, HDAC3, HDAC6, HDAC8, and HDAC10 are molecular targets of the reduced form of lipoic acid and lipoamide. Importantly, only the naturally occurring (R)-enantiomer inhibits HDACs at physiologically relevant concentrations and leads to hyperacetylation of HDAC substrates. The inhibition of HDACs by (R)-lipoic acid and lipoamide explain why both compounds prevent stress granule formation in cells and may also provide a molecular rationale for many other phenotypic effects elicited by lipoic acid.

The Effects of Prolonged Treatment with Cemtirestat on Bone Parameters Reflecting Bone Quality in Non-Diabetic and Streptozotocin-Induced Diabetic Rats.

Cemtirestat, a bifunctional drug acting as an aldose reductase inhibitor with antioxidant ability, is considered a promising candidate for the treatment of diabetic neuropathy. Our study firstly examined the effects of prolonged cemtirestat treatment on bone parameters reflecting bone quality in non-diabetic rats and rats with streptozotocin (STZ)-induced diabetes. Experimental animals were assigned to four groups: non-diabetic rats, non-diabetic rats treated with cemtirestat, diabetic rats, and diabetic rats treated with cemtirestat. Higher levels of plasma glucose, triglycerides, cholesterol, glycated hemoglobin, magnesium, reduced femoral weight and length, bone mineral density and content, parameters characterizing trabecular bone mass and microarchitecture, cortical microarchitecture and geometry, and bone mechanical properties were determined in STZ-induced diabetic versus non-diabetic rats. Treatment with cemtirestat did not affect all aforementioned parameters in non-diabetic animals, suggesting that this drug is safe. In diabetic rats, cemtirestat supplementation reduced plasma triglyceride levels, increased the Haversian canal area and slightly, but insignificantly, improved bone mineral content. Nevertheless, the insufficient effect of cemtirestat treatment on diabetic bone disease does not support its use in the therapy of this complication of type 1 diabetes mellitus.

Pleiotropic Effects of Alpha-Lipoic Acid in Treatment of Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus

INTRODUCTION: Type 2 diabetes mellitus is an urgent problem due to its widespread prevalence and disability of patents in result of macro- and microvascular complications. Diabetic neuropathy (DN) considerably impairs the quality of life of patients. Use of alpha-lipoic acid (ALA) prevents the development of oxidative stress and improves oxidation of fatty acids.&#x0D; AIM: To study the influence of alpha-lipoic acid on the variability of glycemia, lipid spectrum, positive and negative neurological symptoms in patients with DM2 and DN.&#x0D; MATERIALS AND METHODS: The prospective study included 39 patients with DM2 and DN in the clinical stage: patients of group 1 (n = 20) were administered intravenous drip infusion of ALA 600 mg once a day for 2 weeks in hospital conditions followed by intake of 600 mg once a day per os for 2.5 months on an outpatient basis; patients of group 2 (n = 19) did not receive ALA preparations. In all the patients, parameters of lipid and carbohydrate metabolism were studied, pain, tactile, temperature, vibration sensitivity and muscle strength of lower extremities were evaluated.&#x0D; RESULTS: In patients of group 1, after 12 weeks of using ALA, decrease in positive symptoms in the lower legs and feet, improvement in vibration (0.6 0.5 points, p = 0.0095), tactile (0.7 0.6 points, p = 0.037), temperature sensitivity (0.2 0.4 points, p = 0.027), and also decrease in the average value of glycemia (8.7 [7.4; 9.2] mmol/l, p = 0.0078), decrease in glycated hemoglobin with the achievement of the target value (7.5 0.1%, p = 0.046) and improvement of lipid spectrum (total cholesterol 5.9 0.1 mmol/ l, p = 0.043) were recorded; low density lipoproteins 3.6 0.1 mmol/l, p = 0.0076; high density lipoproteins 1.2 0.1 mmol/l, p = 0.034).&#x0D; CONCLUSION: In patients with type 2 diabetes mellitus with diabetic neuropathy in the clinical stage who received preparations of alpha-lipoic acid in complex treatment, reduction of neurologic deficit, of positive neurologic symptoms was achieved in 12 weeks; with that, improvement of lipid spectrum and of glycemic control was found, which may be considered as pleiotropic effects associated with acceleration of mitochondrial biosynthesis.

The Aldose Reductase Inhibitor Epalrestat Maintains Blood–Brain Barrier Integrity by Enhancing Endothelial Cell Function during Cerebral Ischemia

Excessive activation of aldose reductase (AR) in the brain is a risk factor for aggravating cerebral ischemia injury. Epalrestat is the only AR inhibitor with proven safety and efficacy, which is used in the clinical treatment of diabetic neuropathy. However, the molecular mechanisms underlying the neuroprotection of epalrestat remain unknown in the ischemic brain. Recent studies have found that blood–brain barrier (BBB) damage was mainly caused by increased apoptosis and autophagy of brain microvascular endothelial cells (BMVECs) and decreased expression of tight junction proteins. Thus, we hypothesized that the protective effect of epalrestat is mainly related to regulating the survival of BMVECs and tight junction protein levels after cerebral ischemia. To test this hypothesis, a mouse model of cerebral ischemia was established by permanent middle cerebral artery ligation (pMCAL), and the mice were treated with epalrestat or saline as a control. Epalrestat reduced the ischemic volume, enhanced BBB function, and improved the neurobehavior after cerebral ischemia. In vitro studies revealed that epalrestat increased the expression of tight junction proteins, and reduced the levels of cleaved-caspase3 and LC3 proteins in mouse BMVECs (bEnd.3 cells) exposed to oxygen–glucose deprivation (OGD). In addition, bicalutamide (an AKT inhibitor) and rapamycin (an mTOR inhibitor) increased the epalrestat-induced reduction in apoptosis and autophagy related protein levels in bEnd.3 cells with OGD treatment. Our findings suggest that epalrestat improves BBB function, which may be accomplished by reducing AR activation, promoting tight junction proteins expression, and upregulating AKT/mTOR signaling pathway to inhibit apoptosis and autophagy in BMVECs.

COMPREHENSION OF OCCUPATIONAL THERAPIST BACKWARD CHEMOTHERAPY TREATMENT OF DIAMETERS EMBARRASSMENT

Definition of the term JM covers a gaggle of metabolic diseases characterized by elevated blood glucose levels. According to the newest 2016 data from the WHO, 422 million adults live with diameters mellitus. Diameters prevalence is increasing rapidly, because physical inactivity and overweight are risk factors who are increasing too. Embarrassment from diametersmellitus can be treated with physical modalities. The aim of our research was to assess the comprehension of occupational therapists for treatment of embarrassment from diameters mellitus with physical medicine. Material and method: We have designed special questionnaire with 30 inquiries to assess, comprehension for treatment of diabetic food, diabetic ulcer, amputation, and diabetic neuropathy. The data was collected electronically by email. The comprehension was assessed with score: 0-25% poor, 26-50% fair, 51-75%good, 76-100 % excellent. Results: Occupational therapist have had a mean score of 40% of the entire comprehension, rock bottom was backward effect of light therapy on diabetic ulcers and treatment of diabetic neuropathy. Discussion: Treatment of diameters with insulin, is standard in medicine. Physical medicine has important role in prevention of diameters, with promotion of physical activity. Embarrassment of diameters decrease quality of life, with many embarrassment affecting circulation, nerves and bones. Researchers are trying to find new ways of non-pharmacological treatment of embarrassment. Conclusion: Our medical staff have had, fair comprehension backward effect of physical modalities in treatment of embarrassment from JM. Future lectures must contain more attention backward this ill health.

Blockade of receptor for advanced glycation end-products with azeliragon ameliorates streptozotocin-induced diabetic neuropathy.

Treatment options for diabetic neuropathy are suboptimal, so development of a new therapeutic strategy is urgent. We focused on the role of receptor for advanced glycation end-products (RAGE) in diabetic neuropathy. We elaborated the effects of azeliragon (orally available small-molecule antagonist of RAGE) on streptozotocin (STZ)-induced mechanical hypersensitivity in mice. A reduction in mechanical nociceptive threshold observed 28 days after STZ treatment was improved by single administration of azeliragon (10 and 30mg/kg) at 3h, but this effect disappeared at 24h. Conversely, repeat administration (three times; days 28, 30, and 32) of azeliragon (30mg/kg) enhanced the antinociceptive effect significantly compared with that obtained upon single administration, and this effect persisted at least up to 24h. The antinociceptive effect of azeliragon (30mg/kg) was almost comparable with that of pregabalin (30mg/kg). These drug treatments had no effect on blood glucose levels. Our findings suggest that RAGE might be an effective target for diabetic neuropathy treatment.

Mirogabalin - the use of a new gabapentinoid in the treatment of diabetic neuropathy and postherpetic neuropathy and other conditions

Introduction: Mirogabalin is a new drug from the gabapentinoid group first registered in Japan in 2019. It has found use in the treatment of peripheral neuropathic pain in diabetic neuropathy and postherpetic neuropathy. Purpose: In this article, we review studies on the efficacy and safety of mirogabalin in the treatment of registered indications and its potentially new applications. Materials and Methods: We reviewed the literature available in the PubMed database, using the key words: "mirogabalin", "neuropathy" "pregabalin". Results: Mirogabalin has been registered for the treatment of neuropathic pain in diabetic neuropathy and postherpetic neuropathy. The literature shows that it is effective and safe in the above-mentioned indications. Its use has also been described: in the treatment of neuropathic pain of other etiologies with intolerance to pregabalin, as a coanalgesic in the treatment of pain in the course of cancer, and in neuropathy caused by chemotherapy. It has been shown to be effective in all of the aforementioned cases. Studies have shown no clinically significant effect of mirogabalin in the symptomatic treatment of fibromyalgia pain. It has a good safety profile and a low number of adverse effects. Conclusions:. Mirogabalin is a drug that has the potential to improve the efficacy of treatment of neuropathic pain due to various causes. There is a need to continue conducting studies on larger groups of patients in order to make wider use of its potential in clinical practice.

The Use of Alpha-Lipoic Acid Supplementation in Diabetes: The Available Evidence

Dietary health supplements have been increasingly used in the treatment and prevention of chronic disorders. During the previous years, lipoic acid has been reported to have a beneficial effect on diabetes and some of its complications. The aim of this paper is to review the evidence provided by lipoic acid research findings relevant to its use in diabetes. Since, the1950s, there has been an accumulating experimental evidence showing that that lipoic acid, a naturally occurring substance, has a protective effects against the development of diabetes and its complications especially neuropathy. The beneficial use of oral lipoic acid in diabetic neuropathy has been reported mostly from Germany as early as the 1960s. Conclusion: There is convincing research evidence suggesting that lipoic acid has a benerficial effects in diabetes, and is particularly useful in the prevention and treatment of diabetic neuropathy. The beneficial effects of lipoic acid in diabetes and diabetic neuropathy are attributed to increasing insulin sensitivity, reduction of hyperglycemia-induced oxidative stress, and lipid peroxidation. Lipoic acid can possibly help in preventing diabetes in susceptible individuals, and the current expert opinion suggests that lipoic acid can be used in patients with patients with impaired glucose tolerance.

Role of NLRP3 inflammasome in diabetic neuropathy and prevention and treatment with traditional Chinese medicine

As one of the most frequent complications of diabetes, diabetic neuropathy often involves peripheral and central nervous systems. Neuroinflammation is the key pathogenic factor of secondary nerve injury in diabetes. NOD-like receptor pyrin domain-containing 3(NLRP3) inflammasome is a group of subcellular multiprotein complexes, including NLRP3, apoptosis associated speck-like protein(ASC), and pro-cysteinyl aspartate specific proteinase 1(pro-caspase-1). NLRP3 inflammasome is an inducer of innate immune responses. Its activation stimulates the inflammatory cascade reaction, promotes the release of inflammatory mediators, triggers cell death and uncontrolled autophagy, activates glial cells, facilitates peripheral immune cell infiltration, and initiates amyoid β(Aβ)-tau cascade reactions. As a result, it contributes to the central nerve, somatic nerve, autonomic nerve, and retinal nerve cell damage secondary to diabetes. Therefore, due to its key role in the neuroinflammation responses of the body, NLRP3 inflammasome may provide new targets for the treatment of diabetic neuropathy. With multi-target and low-toxicity advantages, traditional Chinese medicine plays a vital role in the treatment of diabetic neuropathy. Accumulating evidence has shown that traditional Chinese medicine exerts curative effects on diabetic neuropathy possibly through regulating NLRP3 inflammasome. Although the role of NLRP3 inflammasome in diabetes and related complications has been investigated in the literature, systematical studies on drugs and mechanism analysis for secondary neuropathy are still lacking. In this article, the role of NLRP3 inflammasome in diabetic neuropathy was explored, and the research progress on traditional Chinese medicine in the treatment of diabetic neuropathy through NLRP3 inflammasome was reviewed.

Diabetic neuropathy and diabetic foot syndrome (update2023)

These are the guidelines for diagnosis and treatment of diabetic neuropathy and diabetic foot.The position statement summarizes characteristic clinical symptoms and techniques for diagnostic assessment of diabetic neuropathy, including the complex situation of the diabetic foot syndrome. Recommendations for the therapeutic management of diabetic neuropathy, especially for the control of pain in sensorimotor neuropathy, are provided. The needs to prevent and treat diabetic foot syndrome are summarized.

Expert Panel opinion «Possibilities of Cytoflavin in Patients with Diabetic Polyneuropathy» based on the results of the study «Efficacy and safety of combined metabolic medication containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multiple-center randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER)»

Expert Panel opinion «Possibilities of Cytoflavin in Patients with Diabetic Polyneuropathy» based on the results of the study «Efficacy and safety of combined metabolic medication containing inosine, nicotinamide, riboflavin and succinic acid, for the treatment of diabetic neuropathy: a multiple-center randomized, double-blind, placebo-controlled parallel group clinical trial (CYLINDER)»