Diabetic neuropathy: therapies for peripheral and autonomic symptoms.

Painful peripheral diabetic neuropathy is a major cause of morbidity in diabetes mellitus. In addition to good glycemic control, therapeutic options include simple analgesics, the occasional use of narcotic analgesics, tricyclic antidepressants, or topically applied capsaicin cream. Other options such as carbamazepine and lidocaine have clinical drawbacks, but some investigational compounds may hold promise in the future. Diabetic autonomic neuropathy is often undiagnosed because of its diffuse organ involvement and gradual onset. Affected organ systems may include the ocular pupil, sweat glands, gastrointestinal tract, bladder, sex organs, cardiovascular system, and adrenal medullary system. Diagnosis requires the exclusion of other causes for the patient's symptoms.