Pathophysiology and Pharmacotherapeutics of Diabetic Neuropathy: A Review

Diabetic neuropathy affects most of the patients with type I & II diabetes. Peripheral neuropathy has devastating consequences resulting in charcot joints and its related complications. American diabetes association helps to classify different type of diabetic neuropathies into groups trying to make some sense of out it for future work. There are number of cellular mechanisms that have been proposed as cause of the neuropathy including polyol pathway, advanced glycosylation end products, oxidative stress, hypoxia theory and other factors. All these have been discussed in some detail in the coming paragraphs. A number of add-on modalities have been discussed in literature to help diagnose diabetic peripheral neuropathy. Understanding the cellular mechanism of diabetic neuropathy can help come up with best therapeutic agents which may be able to arrest that cellular events behind diabetic neuropathy helping to stop it at early stages. A number of medicines are in use to treat diabetic peripheral neuropathy once it is set, however prevention of such cellular changes using medicines or by controlling glucose levels seems to be the future area of work trying to improve outcomes of this devastating illness. Most of the current recommendations for treating established diabetic neuropathy are based on comparing effects of these drugs against placebos in reducing the symptoms of diabetic peripheral neuropathy. This review article tries to find a connection between cellular mechanisms for diabetic peripheral neuropathy with available pharmacotherapeutics and defines areas for future work of pharmacological industry to help find definitive treatment and if possible definitive prevention for diabetic peripheral neuropathy.