RT Journal
A1 Rutkove SB
T1 A 52-year-old woman with disabling peripheral neuropathy: Review of diabetic polyneuropathy
JF JAMA
JO JAMA
YR 2009
FD October 7
VO 302
IS 13
SP 1451
OP 1458
DO 10.1001/jama.2009.1377
UL http://dx.doi.org/10.1001/jama.2009.1377
AB Ms Q is a 52-year-old woman who has had progressive polyneuropathy in the setting of diabetes for the past 8 years. Ms Q's major disability is that of increasingly severe neuropathic pain and cramps that have been poorly responsive to a variety of therapies, including gabapentin and topiramate. The diagnosis of and differential diagnosis for diabetic polyneuropathy are reviewed herein. In general, treatment options for diabetic polyneuropathy remain primarily symptomatic. Improving the metabolic profile through weight loss, exercise, and if necessary, medications may help slow neuropathy progression. Many medications are effective in reducing pain, and newly developed ones, such as pregabalin and duloxetine, while specifically marketed for diabetic neuropathy, are likely to be no better and are considerably more expensive than older ones. α-Lipoic acid appears to be effective as well.