Diagnosing Diabetic Neuropathy: Something Old, Something New

There are potentially many ways of assessing diabetic peripheral neuropathy (DPN). However, they do not fulfill U.S. Food and Drug Administration (FDA) requirements in relation to their capacity to assess therapeutic benefit in clinical trials of DPN. Over the past several decades symptoms and signs, quantitative sensory and electrodiagnostic testing have been strongly endorsed, but have consistently failed as surrogate end points in clinical trials. Therefore, there is an unmet need for reliable biomarkers to capture the onset and progression and to facilitate drug discovery in DPN. Corneal confocal microscopy (CCM) is a non-invasive ophthalmic imaging modality for in vivo evaluation of sensory C-fibers. An increasing body of evidence from multiple centers worldwide suggests that CCM fulfills the FDA criteria as a surrogate endpoint of DPN.

Diabetic neuropathy and painful diabetic neuropathy in the Middle East and North Africa [MENA] region: Much work needs to be done

The prevalence of diabetic peripheral neuropathy and painful diabetic peripheral neuropathy in the Middle East shows huge variability. This reflects the differing diagnostic techniques employed to diagnose neuropathy, but also the heterogeneity of the populations studied and the selection of populations from primary and secondary care. The treatment of diabetic neuropathy per se is inadequate as reflected by the poor control of risk factors such as glucose control, blood pressure and lipids in this region, which translates into the high rates of foot ulceration and amputation. In relation to symptomatic treatment, recommendations based on trials conducted in the West are without question, endorsed for the treatment of populations in the Middle East. Surely the demographics and patient responses both in terms of efficacy and side effects differ and therefore warrant local clinical trials. There is an over reliance on the prescription of B vitamins with the claim that they induce nerve repair. Whilst there is evidence for the relief of neuropathic symptoms with both vitamin B and D, again clinical trials are required in this region to establish their role in the treatment of diabetic neuropathy and painful diabetic neuropathy