Effective drugs for diabetic polyneuropathy pain appear to be underused

  • Jacob L & al.
  • Prim Care Diabetes
  • 6 Jan 2021

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Antiepileptic drug (AED) use is relatively low in patients recently diagnosed with diabetic polyneuropathy (DPN) in Germany.  

Why this matters

  • Neuropathic pain is one of the most common and debilitating DPN symptoms.
  • AEDs such as γ-aminobutyric acid analogues and other anticonvulsants are well-tolerated and associated with decreased peripheral neuropathic pain.  

Study design

  • Retrospective study of 48,324 adults diagnosed with DPN at 1238 German general and diabetologist practices during 2008-2017.  
  • Funding: None.

Key results

  • Within 5 years of DPN diagnosis,16.4% of patients were prescribed ≥1 AED at a median of 150 days, with 30% treated on the day of diagnosis.
  • Most frequent AEDs prescribed were pregabalin (46.7%), gabapentin (45.3%), and carbamazepine (4.2%).
  • Diabetologists were more likely than general practitioners to prescribe pregabalin (55.1% vs 36.8%).
  • After adjustments, significant predictors of AED therapy were (HR; 95% CI):
    • Female sex: 1.22 (1.15-1.30);
    • Private health insurance coverage: 1.22 (1.07-1.40);
    • General practice follow-up: 1.85 (1.69-2.03);
    • HbA1c ≥10%: 1.36 (1.20-1.54);
    • Previous neurology referral: 1.47 (1.33-1.62);
    • Previous hospital admission: 1.51 (1.34-1.70); 
    • Depression diagnosis: 1.15 (1.07-1.24); and
    • Type 1 vs type 2 diabetes: 1.30 (1.09-1.56).

Limitations

  • Lack of detail about severity, complications.
  • Deceased patients counted as lost to follow-up.
  • No data available on treatment follow-up, diabetes duration.