General
- Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy
- 2014: Use of natural compounds in the management of diabetic peripheral neuropathy
- 2014: Standard and emerging treatment options for diabetic neuropathy
- 2012 Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy
- 2012 Diabetic neuropathy: clinical manifestations and current treatments
- 2011 Diabetic neuropathy: cellular mechanisms as therapeutic targets
- 2011 Evidence-based guideline: Treatment of painful diabetic …
Alpha-lipoic acid treatment
- 1995: Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant α-lipoic acid
- 2004: Treatment of symptomatic diabetic polyneuropathy with the antioxidant α‐lipoic acid: a meta‐analysis
- Conclusion: The results of this meta-analysis provide evidence that treatment with α-lipoic acid (600 mg /day i.v.) over 3 weeks is safe and significantly im- proves both positive neuropathic symptoms and neuropathic deficits to a clini- cally meaningful degree in diabetic patients with symptomatic polyneuropathy.
- 2006: Oral Treatment With α-Lipoic Acid Improves Symptomatic Diabetic Polyneuropathy The SYDNEY 2 trial
- Oral treatment with ALA for 5 weeks improved neuropathic symptoms and deficits in patients with DSP. An oral dose of 600 mg once daily appears to provide the optimum risk-to-benefit ratio.
- 2014: Efficacy of α-lipoic acid in diabetic neuropathy
- 2012: THERAPY OF ENDOCRINE DISEASE: A systematic review and meta-analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy
- The results of this meta-analysis provide evidence that treatment with ALA (300–600 mg/day i.v. for 2–4 weeks) is safe and that the treatment can significantly improve both nerve conduction velocity and positive neuropathic symptoms. However, the evidence may not be strong because most of the studies included in this meta-analysis have poor methodological quality.
- 2011: Efficacy and Safety of Antioxidant Treatment With α-Lipoic Acid Over 4 Years in Diabetic Polyneuropathy The NATHAN 1 Trial
- Four-year treatment with ALA in mild-to-moderate DSPN did not influence the primary composite end point but resulted in a clinically meaningful improvement and prevention of progression of neuropathic impairments and was well tolerated. Because the primary composite end point did not deteriorate significantly in placebo-treated subjects, secondary prevention of its progression by ALA according to the trial design was not feasible.
- Painful diabetic neuropathy management
- Other promising modalities from small randomised controlled trials include the use of alpha-lipoic acid as an antioxidant and evening primrose oil through increased PGE1 synthesis. Both treatments improve nerve function and result in symptomatic improvement.[13] The drawbacks for these treatments include chelation of metals such iron and copper with alpha-lipoic acid and inhibition of platelet aggregation with evening primrose oil. Close monitoring of patients on these treatments are advised.[13]
- Ref 13 is Ametov AS, Barinov A, Dyck PJ et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care 2003; 26: 770–776.
- Treatment of diabetes mellitus-associated neuropathy with vitamin E and Eve primrose
- Tutuncu NB, Bayraktar N, Varli K. Reversal of defective nerve conduction with vitamin E supplementation in type 2 diabetes. Diabet Care. 1998;21:1915–8. [PubMed]
- This study shows that defective nerve conduction in diabetic subjects with mild-to-moderate peripheral neuropathy may be improved by pharmacological doses of vitamin E supplementation. Further studies with a larger number of patients for longer periods of time are needed.
- Treatment of diabetes mellitus-associated neuropathy with vitamin E and Eve primrose
- The combination of vitamin E and Eve Primrose is beneficial in the management of mild to moderate diabetic neuropathy.
- 2014: Exercise Intervention Studies in Patients with Peripheral Neuropathy: A Systematic Review
- Overall, balance training appears to be the most effective exercise intervention. Studies focusing exclusively on strength, or a combination of endurance and strength, appear to have a lower impact. For metabolically-induced neuropathies, endurance training also plays an important role. Further research with high methodological quality needs to be conducted in order to establish evidence-based clinical recommendations for neuropathic patients.
- 2014: Acetyl‐L‐carnitine for the treatment of diabetic polyneuropathy
- 2014:Acetyl-L-Carnitine for the Treatment of Peripheral Neuropathic Pain: a Systematic Review and Meta-Analysis
Some people with peripheral neuropathy try complementary and alternative treatments for relief of their symptoms. Although researchers haven’t studied these techniques as thoroughly as they have most medications, the following therapies have shown some promise:
Acupuncture. Acupuncture, which involves inserting thin needles into various points on your body, may reduce peripheral neuropathy symptoms. You may need multiple sessions before you notice improvement. Acupuncture is generally considered safe when performed by a certified practitioner using sterile needles.
Alpha-lipoic acid. Used as a treatment for peripheral neuropathy in Europe for years, this antioxidant may help reduce symptoms. Discuss using alpha-lipoic acid with your doctor because it may affect blood sugar levels. Other side effects may include stomach upset and skin rash.
Herbs. Certain herbs, such as evening primrose oil, may help reduce neuropathy pain in people with diabetes. Some herbs interact with medications, so discuss herbs you’re considering with your doctor.
Amino acids. Amino acids, such as acetyl-L-carnitine, may help improve peripheral neuropathy in people who have undergone chemotherapy and in people with diabetes. Side effects may include nausea and vomiting.
Fish oil. These supplements, which have omega-3 fatty acids, may reduce inflammation, improve blood flow and improve neuropathy symptoms in people with diabetes. Check with your doctor before taking fish oil supplements if you’re taking anti-clotting medications.
Jonathan Eisen's Lab 