An integrated approach to pathogenetic-oriented pharmacotherapy of patients with diabetes mellitus and diabetic distal polyneuropathy

Diabetes mellitus remains a global medical and social problem due to its prevalence, presence of severe complications, and high disability and mortality rates among the population. One of the most common chronic complications of diabetes mellitus is the diabetic distal neuropathy, the main risk factors for the development of which are chronic hyperglycemia, arterial hypertension, obesity, smoking, age, and genetic predisposition of the patient. Diabetic distal neuropathy stems from a complex interaction of metabolic processes, immune system, and genetic predisposition, which result in morphological changes in the form of demyelination and thickening of axons, a decrease in the number of Schwann cells, as well as disruption of the structure of the Ranvier nodes. Sensory and motor disorders are manifested by a decrease in all types of sensitivity, weakening of reflexes. Asymptomatic course is observed in 50% of patients with diabetic distal neuropathy. Ideal methods for early diagnosis and therapy of patients with diabetic distal neuropathy do not exist. Controversial issues of diabetic distal neuropathy treatment mainly concern the use of В vitamins and alpha-lipoic acid preparations. Some studies of the alpha-lipoic acid have determined its anti-inflammatory, antioxidant properties, as well as its possible effect on carbohydrate metabolism in patients with diabetic distal neuropathy. B vitamins have long been used as an additional therapy for patients with diabetic distal neuropathy. Clinical experience in treating patients with diabetic distal neuropathy shows that the best result is achieved by using a combination of alpha-lipoic acid and B1, B6, B12 vitamins which is due to their synergistic effect. This review examines the issues of complex pathogenetic therapy of diabetic distal neuropathy in patients with diabetes mellitus.