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Clinical Crossroads
Clinician's Corner
October 7, 2009

A 52-Year-Old Woman With Disabling Peripheral NeuropathyReview of Diabetic Polyneuropathy

Author Affiliations

Author Affiliation: Dr Rutkove is Associate Professor of Neurology, Harvard Medical School, and Chief of the Division of Neuromuscular Disease, Department of Neurology, at Beth Israel Deaconess Medical Center, Boston, Massachusetts.

JAMA. 2009;302(13):1451-1458. doi:10.1001/jama.2009.1377

Ms Q is a 52-year-old woman who has had progressive polyneuropathy in the setting of diabetes for the past 8 years. Ms Q's major disability is that of increasingly severe neuropathic pain and cramps that have been poorly responsive to a variety of therapies, including gabapentin and topiramate. The diagnosis of and differential diagnosis for diabetic polyneuropathy are reviewed herein. In general, treatment options for diabetic polyneuropathy remain primarily symptomatic. Improving the metabolic profile through weight loss, exercise, and if necessary, medications may help slow neuropathy progression. Many medications are effective in reducing pain, and newly developed ones, such as pregabalin and duloxetine, while specifically marketed for diabetic neuropathy, are likely to be no better and are considerably more expensive than older ones. α-Lipoic acid appears to be effective as well.