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Diabetes Mellitus, Type 1 > Drug Therapy Author: Maureen D. Passaro, MD; Robert E. Ratner, MD
Editorial changes - 2012-02-07
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Rationale:

  • Neuropathy is predictive of eventual foot ulceration. Early detection is associated with fewer ulcerations and amputations.

Evidence:

  • A Cochrane systematic review concluded that the number needed to treat for achievement of at least moderate pain relief with a TCA or venlafaxine was 3 (119). Another study provides information about the pharmacologic management of painful diabetic neuropathy (120).
  • Peripheral neuropathy as determined by vibration and monofilament testing is associated with an 8% to 18% higher risk of ulceration (121; 122).
  • A systematic review showed that TCAs, anticonvulsants, and opioids are effective in treating painful peripheral neuropathy. In addition, it suggested that TCAs and traditional anticonvulsants are better for short-term pain relief compared to newer anticonvulsants (123).

Comments:

  • Note that TCAs frequently have intolerable anticholinergic side effects and must be titrated based on the balance between pain relief and side effects.

FAQs
Abd A. Tahrani, MD, MRCP, editorial consultant, received a grant from the UK Novo Nordisk Research Foundation. Maureen D. Passaro, MD has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Robert E. Ratner, MD, is a consultant for Amylin Pharmaceuticals, AstraZeneca, GlaxoSmithKline, Lifescan, Inc., NovoNordisk, Sanofi-Aventis, Takeda, owns stocks in Merck, Johnson & Johnson, Abbott, received grants from Amylin, AstraZeneca, Bayhill Therapeutics, Boehringer Ingelheim, Conjuchem, Inc., Eil Lilly, GlaxoSmithKline, Merck, NovoNordisk, Pfizer, Sanofi-Aventis, Takeda.
Deborah Korenstein, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations. Richard B. Lynn, MD, FACP, Co-Editor, PIER, has no financial relationships with pharmaceutical companies, biomedical device manufacturers, or health-care related organizations.

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