A 55 year old female presented with tingling sensation in her hands and feet & pain in her legs during night time. She had type 2 diabetes for 15 years. O/E- loss of ankle deep tendon reflex, loss of position sense of great toe, decreased pinprick sensation over ankles & wrists. Her recent HbA1c was 8.9%. She is currently managed with insulin and metformin. She is diagnosed with diabetic polyneuropathy. Which of the following medications can be used to treat pain associated with diabetic neuropathy?: (A) Duloxetine, (B) Topiramate, (C) Piroxicam, (D) Naproxen
Answer is A. Diabetic neuropathy can manifests as polyneuropathy, mononeuropathy, and/or autonomic neuropathy. The most common form is distal symmetric polyneuropathy- presents as distal sensory loss and pain. Management: Improved glycemic control Neurotoxins (alcohol, smoking, and vitamin deficiencies) should be avoided. Only two agents--duloxetine and pregabalin--have been approved by the U.S. FDA for the treatment of diabetic neuropathy. Other off-label agents- amitriptyline, gabapentin, valproate, and opioids.