Diabetes is one of the most common diseases impacting world population. Apart from being a serious illness and having many adverse outcomes, it may present further danger to the patients’ health condition by various complications. Neuropathy and retinopathy are dangerous complications of Type 2 Diabetes, and the providers need to choose alternative agents for diabetes treatment if their patients have such complications.
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Diabetic neuropathy (DN) comprises a large group of health disorders which may have divergent anatomic allocation, clinical sequence, and the fundamental pathophysiological features. DN indicates problems with microvascular and metabolic systems which lead to the axonal decline of small and large nerve fibers (Martin, Albers, & Pop-Busui, 2013).
Depending on the size and allocation of the fibers impacted by DN, the disease may develop into such types as diabetic peripheral neuropathy (DPN) and cardiovascular autonomic neuropathy (CAN) (Martin et al., 2013). Tahrani et al. (2012) argue that DN may be a cause of obstructive sleep apnea (OSA). Both of these conditions are connected with oxidative stress and inflammation (Tahrani et al., 2012). The research results demonstrate that DN and OSA are connected, and the most likely mechanisms of the link are impaired microvascular regulation and increased nitrosative/oxidative stress (Tahrani et al., 2012).
The mentioned considerations require special concern of the providers to approach agent selection for the treatment of diabetes. Ibrahimpasic (2013) has investigated the impact of alpha-lipoic acid (LA) on diabetic patients who have developed DN. The results of the study indicate that alpha-LA is an effective treatment of DN, and it produces a particularly positive impact on the patients with good glycaemic control (Ibrahimpasic, 2013).
Xu et al. (2013) also consider LA a successful treatment method for DN in diabetic patients. They research the differences in treatment with LA alone and in a combination with methylcobalamin (Xu et al., 2013). The results show that the combined treatment of LA and methylcobalamin is more effective than administering LA alone (Xu et al., 2013). The treatment does not present any complications when combined with diabetes drugs.
Retinopathy is another serious problem which may derive from diabetes. The threat implied by this complication results in severe damage to sight and may even cause blindness (Bandello, Lattanzio, Zucchiatti, & Del Turco, 2013). Identification of a variety of cell types concerned with diabetic retinopathy (DR) made it possible to come up with innovative treatment methods. The major role in DR belongs to such proinflammatory and vasoactive molecules as the vascular endothelial growth factor (VEGF) (Bandello et al., 2013). The most effective agents employed for DR treatment are laser photocoagulation and intravitreal injections (Bandello et al., 2013).
Neurodegeneration is considered to be a growing cause of DR (Simó & Hernández, 2012). A suggested approach to the treatment of this condition is a topical administration of neuroprotective drugs, such as brimonidine (Simó & Hernández, 2012). So far, no adverse outcomes of the use of this drug for the diabetic patient with DR have been reported. However, the level of investigation of their use is still low (Simó & Hernández, 2012).
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Another drug suggested for DR patients is fenofibrate (Wong, Simó, & Mitchell, 2012). The risk-benefit ratio allows to conclude that the treatment with this drug eliminates the spread of DR in Type 2 Diabetes patients. The drugs used for DR treatment do not present any danger in combination with diabetes drugs since DR drugs are mainly administered by local application.
Bandello, F., Lattanzio, R., Zucchiatti, I., & Del Turco, C. (2013). Pathophysiology and treatment of diabetic retinopathy. Acta Diabetologica, 50(1), 1-20.
Ibrahimpasic, K. (2013). Alpha lipoic acid and glycaemic control in diabetic neuropathies at type 2 diabetes treatment. Medical Archives Journal, 67(1), 7-9.
Martin, C., Albers, J. W., & Pop-Busui, R. (2013). Neuropathy and related findings in the diabetes control and complications trial/epidemiology of diabetes interventions and complications study. Diabetes Care, 37(1), 31-38.
Simó, R., & Hernández, C. (2012). Neurodegeneration is an early event in diabetic retinopathy: Therapeutic implications. British Journal of Ophthalmology, 96(10), 1285-1290.
Tahrani, A. A., Ali, A., Raymond, N. T., Begum, S., Dubb, K., Mughal, S.,… Stevens, M. J. (2012). Obstructive sleep apnea and diabetic neuropathy a novel association in patients with type 2 diabetes. American Journal of Respiratory and Critical Care Medicine, 186(5), 434-441.
Wong, T. Y., Simó, R., & Mitchell, P. (2012). Fenofibrate – a potential systemic treatment for diabetic retinopathy? American Journal of Ophthalmology, 154(1), 6-12.
Xu, Q., Pan, J., Yu, J., Liu, X., Liu, L., Zuo, X.,… Ji, A. (2013). Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy. Diabetes Research and Clinical Practice, 101(2), 99-105.