[Intensified insulin therapy plus antineuritic medication is more effective than antineuritics alone in painful diabetic neuropathy].

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
• Journal: Revista medica de Chile (Rev Med Chil) Vol. 134 Issue 12 Pg. 1507-15 (Dec 2006) ISSN: 0034-9887 [Print] Chile
• Vernacular Title: La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa.
• PMID: 17277866 (Publication Type: Journal Article)

Chemical References

• Adrenergic Uptake Inhibitors
• Amines
• Analgesics
• Cyclohexanecarboxylic Acids
• Glycated Hemoglobin A
• Hypoglycemic Agents
• Insulin
• gamma-Aminobutyric Acid
• Gabapentin
• Nortriptyline
• Clomipramine

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
• Gabapentin
• Glycated Hemoglobin (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)