Neurology, Neuropsychiatry, Psychosomatics

Advanced search

Diabetic polyneuropathy: diagnosis, prevention, and treatment

Full Text:


The most common form of peripheral nervous system damage in diabetes mellitus is distal symmetric sensorimotor polyneuropathy (DSSMPN). Chronic hyperglycemia, dyslipidemia, and impaired microcirculation are considered to be the key mechanisms for the development of DSSMPN, but its pathogenesis is still unclear and continues to be studied. The paper analyzes the issues of diagnosis of DSSMPN and the effective principles of patient treatment. It also discusses the use of alpha-lipoic acid (ALA) as a drug for the pathogenetic treatment of DSSMPN and describes the results of clinical trials of its treatment with ALA preparations.

About the Authors

V. A. Golovacheva
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Veronika Aleksandrovna Golovacheva

Department of Nervous System Diseases and Neurosurgery, Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021

I. A. Strokov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Department of Nervous System Diseases and Neurosurgery, Institute of Clinical Medicine

11, Rossolimo St., Build. 1, Moscow 119021


1. Sadyrin AV, Karpova MI, Dolganov MV. Diabetic polyneuropathy: pathogenesis issues and possibilities. RMZh. 2016;(1):47-50. Available at: (In Russ.).

2. Tesfaye S, Boulton AJ, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments [published correction appears in Diabetes Care. 2010 Dec;33(12):2725]. Diabetes Care. 2010;33(10):2285-93. doi: 10.2337/dc10-1303

3. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43:817-24. doi: 10.1212/WNL.43.4.817

4. Suntsov YuI, Maslova OV, Dedov II. Screening for complications of diabetes mellitus as a method of evaluating the treatment and care of patients. Problemy endokrinologii. 2010;56(1):3-8. Available at: (In Russ.).

5. Kasznicki J. Advances in the diagnosis and management of diabetic distal symmetric polyneuropathy. Arch Med Sci. 2014;10(2):345-54. doi: 10.5114/aoms.2014.42588

6. Sloan G, Shillo P, Selvarajah D, et al. A new look at painful diabetic neuropathy. Diab Res Clin Pract. 2018;144:177-91. doi: 10.1016/j.diabres.2018.08.020

7. Kioskli K, Scott W, Winkley K, et al. Psychosocial factors in painful diabetic neuropathy: a systematic review of treatment trials and survey studies. Pain Med. 2019;20:1756-73. doi: 10.1093/pm/pnz071

8. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature. 2001;414(6865):813-20. doi: 10.1038/414813a

9. Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012;6(6):CD007543. doi: 10.1002/14651858.CD007543.pub2

10. Brownlee M. The pathobiology of diabetic complications: a unifying mechanism. Diabetes. 2005;54(6):1615-25. doi: 10.2337/diabetes.54.6.1615

11. Andersen ST, Witte DR, Dalsgaard EM, et al. Risk factors for incident diabetic polyneuropathy in a cohort with screen-detected type 2 diabetes followed for 13 years: ADDITION-Denmark. Diabetes Care. 2018;41:1068-75. doi: 10.2337/dc17-2062

12. Ziegler D, Rathmann W, Dickhaus T, et al. Neuropathic pain in diabetes, prediabetes and normal glucose tolerance: the MONICA/KORA Augsburg Surveys S2 and S3. Pain Med. 2009;10:393-400. doi: 10.1111/j.15264637.2008.00555.x

13. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-62. doi: 10.2337/diacare.28.4.956

14. Yang H, Sloan G, Ye Y, et al. New perspective in diabetic neuropathy: from the periphery to the brain, a call for early detection, and precision medicine. Front Endocrinol (Lausanne). 2020;10:929. doi: 10.3389/fendo.2019.00929

15. International statistical classification of diseases and problems related to health. Tenth revision. (IDC-10). Geneva; 1995. Available at:

16. Parfenov VA, Golovacheva VA, Fadeev VV, et al. Optimization diabetic polyneuropathy patients management using a multidisciplinary approach. Meditsinskiy sovet = Medical Council. 2017;(1S):71-9. doi: 10.21518/2079-701X-20170-71-79 (In Russ.).

17. Ang L, Jaiswal M, Martin C, Pop-Busui R. Glucose control and diabetic neuropathy: lessons from recent large clinical trials. Curr Diab Rep. 2014;14(9):528. doi: 10.1007/s11892-014-0528-7

18. Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alpha-lipoic acid. A 3-week multicentre randomized controlled trial (ALADIN Study). Diabetologia. 1995;38(12):1425-33. doi: 10.1007/BF00400603

19. Ziegler D, Reljanovic M, Mehnert H, Gries FA. Alpha-lipoic acid in the treatment of diabetic polyneuropathy in Germany: current evidence from clinical trials. Exp Clin Endocrinol Diabetes. 1999;107(7):421-30. doi: 10.1055/s-0029-1212132

20. Ametov AS, Barinov A, Dyck PJ, et al. The sensory symptoms of diabetic polyneuropathy are improved with alpha-lipoic acid: the SYDNEY trial. Diabetes Care. 2003;26(3):770-6. doi: 10.2337/diacare.26.3.770

21. Ziegler D, Nowak H, Kempler P, et al Treatment of symptomatic diabetic polyneuropathy with antioxidant alpha-lipoic acid: a metaanalysis. Diabet Med. 2004;21(2):114-21. doi: 10.1111/j.1464-5491.2004.01109.x

22. Strokov IA, Fokina AS, Golovacheva VA. Alpha-lipoic acid – a proper choice for the treatment of diabetic neuropathy? Effektivnaya farmakoterapiya. Nevrologiya i psikhiatriya. 2013;32(3):40-6. Available at: (In Russ.).

23. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054-60. doi: 10.2337/dc11-0503

24. Pimonova II. The use of the drug Thiogamma in diseases of the peripheral nervous systemy. Meditsinskiiy vestnik. 2010;21:526 (In Russ.).

25. Podachina SV, Mkrtumyan AM. Milgamma compositum – the drug of choice in the treatment of diabetic neuropathy. RMZh. 2008;28:1887. Available at: (In Russ.).

26. Order of the Ministry of Health of the Russian Federation dated December 28, 2012 No. 1577n «On approval of the standard of primary health care for diabetic polyneuropathy». Available at: (In Russ.).

27. Strokov IA, Fokina AS, Strokov KI, Drokonova OO. Modern principles for the diagnosis and treatment of diabetic polyneuropathy. Meditsinskiy sovet. 2014;(5):38-43. doi: 10.21518/2079-701X-2014-5-38-43 (In Russ.).

28. Golovacheva VA, Parfyonov VA. Management of patients with diabetic polyneuropathy: current guidelines for diagnosis and treatment, prospects for pharmacotherapy. Meditsinskiy sovet = Medical Council. 2015;(18):24-9. doi: 10.21518/2079-701X-2015-18-24-29 (In Russ.).

29. Akhmedzhanova LT, Barinov AN, Solokha OA, et al. Diabetic polyneuropathy: a current algorithm for patient management. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(2):100-5. doi: 10.14412/2074-2711-2019-2-100-105 (In Russ.).

30. Stakhovskaya LV, Gromova OA, Torshin IYu, Filimonova MV. Antitumor effects of the combined use of vitamins B 1 , B 6 and B 12 . Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, neuropsychiatry, psychosomatics. 2017;9(4):101-5. doi: 10.14412/2074-2711-2017-4-101-105 (In Russ.).

31. Golovacheva VA, Golovacheva AA. Therapy for acute nonspecific back pain: new additional opportunities. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2018;10(4):123-8. doi: 10.14412/2074-2711-2018-4-123-128 (In Russ.).

32. Emelyanova AYu, Zinovyeva OE, Fedoseev SR, Misyuryaeva EV. Neurological complications of alcoholic disease and ways of their correction. Nevrologiya, neiropsikhiatriya, psikhosomatika = Neurology, Neuropsychiatry, Psychosomatics. 2019;11(3):124-8. doi: 10.14412/2074-27112019-3-124-128 (In Russ.).

33. Parfenov VA, Golovacheva VA. Diagnosis and treatment of acute low back pain. Therapeutic Archive. 2019;91(8):155-9. doi: 10.26442/00403660.2019.08.000315 (In Russ.).

34. Ang CD, Alviar MJ, Dans AL, et al. Vitamin B for treating peripheral neuropathy. Cochrane Database Syst Rev. 2008;(3):CD004573. doi: 10.1002/14651858.CD004573.pub3

35. Strokov IA, Akhmedzhanova LT, Solokha OA. The use of high doses of B vitamins in neurology. Trudnyy patsiyent. 2009;(10):17-22. Available at: (In Russ.).

36. Vertkin AL, Gorodetskiy VV. What is the advantage of benfotiamine-containing drugs Milgamma and Benfogamma in the treatment of diabetic polyneuropathy.. Farmateka. 2006;(11):83-9. Available at: (In Russ.).

37. Markina OA. The importance of the dosage form and route of administration of B vitamins to provide effective treatment for diabetic polyneuropathy. Klinicheskaya farmakologiya i terapiya. 2003;(2):6-9. Available at: (In Russ.).

38. Meleshkevich TA, Luchina YEI, Lukashova ME. The experience of using the drug Milgamma in the conditions of the endocrinological department. RMZh. 2010;14:907. Available at: (In Russ.).

For citation:

Golovacheva V.A., Strokov I.A. Diabetic polyneuropathy: diagnosis, prevention, and treatment. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(4):113-118. (In Russ.)

Views: 63

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 2074-2711 (Print)
ISSN 2310-1342 (Online)