Need for pathogenetically oriented therapy of neuropathy in diabetes mellitus

Peripheral and/or autonomous neuropathy is associated with increased cardiovascular risk in diabetes patients. One of the common pathogenetic factors is increased production of free oxygen radicals and their derivatives; a hyperglycaemic metabolism impairs endoneural blood perfusion, leading to neuronal cell damage as typical in diabetic neuropathy. The aim of pathogenetically oriented treatment is to slow down, stop, or reverse the progression of neuropathic damage, and clear indications show that benfotiamine and alpha-lipoic acid along with blood glucose optimization and risk factor management may have a positive effect on the processes involved in neuropathy. Benfotiamine inhibits pathways involved in developing neuropathy while stimulating pathways that play a role in improving neuropathy, such as the pentose-phosphate shunt. Alpha-lipoic acid - an effective antioxidant - may partly inhibit pathogenetic processes caused by oxidative stress. Both of these substances have been shown better tolerance profiles than drugs aimed at controlling symptoms, and should play a role in treating patients with diabetic neuropathy.