Diabetic peripheral neuropathy (DPN) is a major complication of diabetes mellitus, which can be prevented by tight glycaemic management focused on lowering hemoglobin A1C and increasing time in the target glucose range, along with managing metabolic risk factors. However, the evidence rarely supports the efficacy of glycaemic and metabolic control in reducing the symptoms and complications of DPN, including pain. 

Physicians can treat DPN with pharmacological agents and non-pharmacological interventions such as foot care and lifestyle modifications. Pharmacological agents predominantly address pain symptoms, which affect 25–35% of people with DPN. 

First-line agents comprise anticonvulsants (pregabalin and gabapentin), serotonin-norepinephrine reuptake inhibitors (duloxetine and venlafaxine), and secondary amine tricyclic antidepressants (nortriptyline and desipramine). All agents possess their own pharmacological, safety, and clinical profiles; thus, they must be selected based on the presence of comorbidities, the potential for adverse effects, drug interactions and costs. 

Even with the current treatment options, physicians commonly prescribe less than the recommended dose of medications, causing poor management of DPN symptoms and treatment discontinuation. Hence they should follow the latest therapy algorithms and treatment options to improve the care for people with DPN.

Drugs Context. 2022 Jun 14;11:2021-10-2. DOI: 10.7573/dic.2021-10-2. PMID: 35775075; PMCID: PMC9205568.