La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa

Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 200...

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Autores principales:	Bastías A,M Juliana, Toro C,Luis, Olmos C,Pablo
Lenguaje:	Spanish / Castilian
Publicado:	Sociedad Médica de Santiago 2006
Materias:	Diabetic neuropathies Gabapentin Hemoglobins Insulin, long-acting
Acceso en línea:	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200003
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spelling	oai:scielo:S0034-988720060012000032007-01-24La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosaBastías A,M JulianaToro C,LuisOlmos C,Pablo Diabetic neuropathies Gabapentin Hemoglobins Insulin, long-acting Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. Material and methods: Review of medical records of 17 type-2 diabetic patients, aged 63±11 years and a duration of diabetes of 15±8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in ~0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. Results: After 1 year, glycosilated hemoglobin decreased from 10.0±1.4% to 7.7±1.2% (p~=0.003). Pain decreased from 10 to 5.1±3.3 at one month, 2.3±3.2 at six months, and 3.1±3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. Conclusions: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reductioninfo:eu-repo/semantics/openAccessSociedad Médica de SantiagoRevista médica de Chile v.134 n.12 20062006-12-01text/htmlhttp://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200003es10.4067/S0034-98872006001200003
institution	Scielo Chile
collection	Scielo Chile
language	Spanish / Castilian
topic	Diabetic neuropathies Gabapentin Hemoglobins Insulin, long-acting
spellingShingle	Diabetic neuropathies Gabapentin Hemoglobins Insulin, long-acting Bastías A,M Juliana Toro C,Luis Olmos C,Pablo La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
description	Background: The basis of the treatment of painful diabetic neuropathy is the use of drugs that block the transmission of pain (antineuritics) and a good metabolic control of underlying disease. Aim: To describe the outcomes of 17 type-2 diabetics with painful neuropathy, treated between 1988 and 2005 with symptomatic therapy plus intensified insulin. Material and methods: Review of medical records of 17 type-2 diabetic patients, aged 63±11 years and a duration of diabetes of 15±8 years. All patients received intensified insulin therapy with 0.35 units/kg of NPH insulin (2/3 before breakfast and 1/3 evening meal), plus capillary glucose measurements and regular insulin (with sliding-scale centered in ~0.1 units/kg) before the 3 main meals. All patients were also treated with gabapentin, nortriptyline or clomipramine. Pain was assessed using a visual analog score of 10 points. Results: After 1 year, glycosilated hemoglobin decreased from 10.0±1.4% to 7.7±1.2% (p~=0.003). Pain decreased from 10 to 5.1±3.3 at one month, 2.3±3.2 at six months, and 3.1±3.6 at 1 year (p <0.01). There was a direct statistical correlation between the reduction of HbA1C and pain decline (r =0.736; p =0.037). Pain scores were lower than those reported elsewhere for Pregabalin (n =76; p =0.05), Lamotrigine (n =27; p <0.0005), Topiramate (n =208; p <0.005), and Gabapentin (n =84; p <0.025). The lack of difference to Sodium Valproate (n =21; p =0.07) had borderline significance. Conclusions: The addition of intensified insulin therapy to the symptomatic treatment of painful neuropathy in type-2 diabetics, significantly enhanced the reduction of pain. The lowering of glycosilated hemoglobin was a significant predictor of success in pain reduction
author	Bastías A,M Juliana Toro C,Luis Olmos C,Pablo
author_facet	Bastías A,M Juliana Toro C,Luis Olmos C,Pablo
author_sort	Bastías A,M Juliana
title	La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
title_short	La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
title_full	La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
title_fullStr	La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
title_full_unstemmed	La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
title_sort	la insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa
publisher	Sociedad Médica de Santiago
publishDate	2006
url	http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0034-98872006001200003
work_keys_str_mv	AT bastiasamjuliana lainsulinoterapiaintensificadamasantineuriticosessuperioraantineuriticopuroenneuropatiadiabeticadolorosa AT torocluis lainsulinoterapiaintensificadamasantineuriticosessuperioraantineuriticopuroenneuropatiadiabeticadolorosa AT olmoscpablo lainsulinoterapiaintensificadamasantineuriticosessuperioraantineuriticopuroenneuropatiadiabeticadolorosa
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La insulinoterapia intensificada más antineuríticos es superior a antineurítico puro en neuropatía diabética dolorosa

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