| Abstract | BACKGROUND: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. AIM: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. MATERIAL AND METHODS: Review of medical records of 17 type-2 diabetic patients, aged 63+/-11 years and a duration of diabetes of 15+/-8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in approximately 0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. RESULTS: After 1 year, glycosilated hemoglobin decreased from 10.0+/-1.4% to 7.7+/-1.2% (p approximately =0.003). Pain decreased from 10 to 5.1+/-3.3 at one month, 2.3+/-3.2 at six months, and 3.1+/-3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. CONCLUSIONS: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction. |
| Authors | M Juliana Bastías A, Luis Toro C, Pablo Olmos C
(Affiliation: Departamento de Nutrición, Diabetes y Metabolismo, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.)
|
| Journal | Revista médica de Chile
(Rev Med Chil)
Vol. 134
Issue 12
Pg. 1507-15
(Dec 2006)
ISSN: 0034-9887 Chile |
| Vernacular Title | La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa. |
| PMID | 17277866
(Publication Type: English Abstract, Journal Article)
|
| Chemical References |
- Adrenergic Uptake Inhibitors
- Amines
- Analgesics
- Cyclohexanecarboxylic Acids
- Hemoglobin A, Glycosylated
- Hypoglycemic Agents
- Insulin
- Clomipramine
- gamma-Aminobutyric Acid
- gabapentin
- Nortriptyline
|
| Topics |
- Adrenergic Uptake Inhibitors
(administration & dosage)
- Adult
- Aged
- Amines
(administration & dosage)
- Analgesics
(administration & dosage)
- Clomipramine
(administration & dosage)
- Cyclohexanecarboxylic Acids
(administration & dosage)
- Diabetes Mellitus, Type 2
(complications, drug therapy)
- Diabetic Neuropathies
(complications, drug therapy)
- Drug Therapy, Combination
- Hemoglobin A, Glycosylated
(analysis)
- Humans
- Hypoglycemic Agents
(administration & dosage)
- Insulin
(administration & dosage)
- Longitudinal Studies
- Male
- Middle Aged
- Neuralgia
(drug therapy, etiology)
- Nortriptyline
(administration & dosage)
- Retrospective Studies
- gamma-Aminobutyric Acid
(administration & dosage)
|
