DIABETIC NEUROPATHY: STILL A CHALLENGE IN PHARMACOLOGY.

Diabetic neuropathy is one of the most serious microvascular complications of diabetes, which appears in about 50% of the patients suffering from diabetes. It is a nerve disorder caused by diabetes, characterized usually by numbness, pain or tingling in the feet or legs, which can lead to serious problems. Patients with diabetic neuropathy suffer from various types of pain. The underlying mechanisms include hyperglycaemia, insulin deficiency, oxidative stress, nitrosative stress, ischaemia, osmolyte accumulation, neurotropic factors deficiency, autoimmune-mediated nerve destruction, alterations in cellular signal pathways and gene expression of proteins. The factors leading to the development of peripheral neuropathy in diabetes are not understood completely, and multiple hypotheses have been advanced which include the polyol pathway, non-enzymatic glycation, oxidative stress, altered neurotropism and apoptosis. At present, there is no clinically proven efficacious drug specifically designated for the treatment of diabetic neuropathy; however, prevention or retardation of the progress of diabetic neuropathy is considered to depend on various antidiabetics, antioxidants, anti-depressants, anticonvulsants, NSAIDs, etc. The new advances in the development of neurotrophic factors and aldose reductase inhibitors herald the host of potentially combined treatments in the field of DN. The use of neurotrophic factors appears to be the most exciting approach because of the potential for the reversibility and regeneration of nerves.