Background & Aims

Diabetic neuropathy is a common complication in individuals with diabetes. Painful diabetic neuropathy (PDN) is a debilitating condition in patients with long-standing diabetes, contributing to mood disturbances and impairment of daily functions. Various guidelines exist for the pharmacologic management of PDN, but there is limited scrutiny regarding whether medications are prescribed in accordance with current PDN guidelines. Therefore, our objective is to review the recently prescribed medications for PDN in our clinic.

Methods

A total 226 patients visited our hospital from January to December 2023. Patients who did not regularly attend our neurology clinic or those without neuropathic pain were excluded. PDN was considered if there were symptoms or signs of neuropathic pain with ‘confirmed diabetic peripheral neuropathy’ based on Toronto Census criteria. Finally, we retrospectively reviewed 131 patients. The study investigated types of neuropathy, medications, initial and current visual analogue scale (VAS), pain improvement or not, and changes in glycated hemoglobin (HbA1c). Pain improvement was defined as a decrease of more than 3 points in the VAS score from the initial value.

Results

The mean age of the patients was 62.2 ± 12.9 year, and 71.8% were males. Electrophysiological studies mostly showed symmetric sensorimotor polyneuropathy (87.0%). Medications for neuropathic pain had been prescribed for an average of 49.9 ± 40.9 months. Pregabalin was most commonly prescribed medication (69.5%) for neuropathic pain, followed by opioids (38.5%). Nearly half of the patients had undergone combination therapy (45.0%). However, only 53 patients (40.5%) reported satisfaction with their symptom improvement. The average dose of each medication was significantly lower than the recommended doses based on current guidelines.

Conclusions

PDN is truly debilitating condition in patients with diabetes. In our study, most patients expressed dissatisfaction with current neuropathic pain medications. Therefore, an improvement in the medication regimen is currently warranted.

References

1. Jinguan L, Litian M, Jianfang F, Different Drugs for the Treatment of Painful Diabetic Peripheral Neuropathy: A Meta-Analysis, Front Neurol. 2021(12):682244
2. Preston FG, Riley DR, Azmi S, Alam U, Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management, Diabet Metab Synd Ob, 2023:16;1595-1612
3. Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S, Rajbhandari S, Sharma S, Rayma G et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial, Lancet, 2022;400;680-90
4. Raymond P, Smith D, Franklin G, Gronseth G, Pignone M, Dabid WS, Armon C, Perkins BA, Bril V, Rae-Grant A, Halperin J et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary, Neurology, 2022;98:31-43

Presenting Author

Je Hong Min

Poster Authors

Je Hong Min

M.D.

Department of Neurology, Ajou University Medical Center, Suwon, Korea

Lead Author

Topics

  • Treatment/Management: Pharmacology: OTC Pain Relief