Neuropathy

Health Condition

Neuropathy

  • Acetyl-L-Carnitine

    Taking acetyl-L-carnitine can reduce pain in people with diabetic neuropathy, but does not appear to consistently benefit cases of chemotherapy-induced neuropathy.

    Dose:

    500 to 1,000 mg three times daily
    Acetyl-L-Carnitine
    ×

    Acetyl-l-carnitine has been found to reduce diabetic peripheral neuropathy in multiple controlled clinical trials. A meta-analysis included data from four trials: the subjects in three trials had diabetic peripheral neuropathy and those in the fourth trial had peripheral neuropathy due to antiretroviral therapy for HIV. The analysis found a 20.2% greater reduction in pain in people treated with acetyl-l-carnitine compared to placebo.5

    Findings from trials examining the use of acetyl-l-carnitine for chemotherapy-induced peripheral neuropathy have been mixed: While several uncontrolled trials have reported decreased nerve pain in cancer patients using various chemotherapy agents, others have noted no effect.5,7 In one placebo-controlled trial that included 239 patients with chemotherapy-induced neuropathy, those who received 3 grams daily of acetyl-l-carnitine were more likely to have pain reduction and nerve function improvement.8 Conversely, another placebo-controlled trial that included 409 breast cancer patients treated with a class of chemotherapy agents called taxanes found treatment with acetyl-l-carnitine increased the severity of chemotherapy-induced neuropathy over 24 weeks and this effect persisted more than 1.5 years after the end of treatment.9

  • Magnesium

    Supplementing with magnesium may reverse poor magnesium status and improve diabetic peripheral neuropathy, but does not appear to be helpful for preventing or treating chemotherapy-induced neuropathy.

    Dose:

    200 to 600 mg daily
    Magnesium
    ×

    People with diabetes frequently have low magnesium levels, and low magnesium is correlated with poor blood glucose control and high risk of diabetes complications, including peripheral neuropathy.9,10,11 In a controlled trial that included 97 magnesium-depleted participants with type 1 diabetes, taking 300 mg of magnesium daily for five years improved magnesium status and decreased or stabilized neuropathic symptoms in 88% of subjects; on the other hand, 61% of those not taking magnesium had worsening of neuropathic symptoms.12

    Low magnesium intake has also been associated with greater risk and severity of chemotherapy-induced neuropathy, but intravenous magnesium has not been found to be beneficial in cancer patients being treated with platinum-based chemotherapies.13,14

  • Vitamin B6, Vitamin B12, and Folic Acid

    B vitamins, and vitamin B12 in particular, may be helpful in treating various types of neuropathies. People with type 2 diabetes taking metformin should be monitored for B12 deficiency.

    Dose:

    2,000 mcg methylcobalamin (B12); 3,000 mcg methylfolate (B9); and 35 mg pyridoxal 5-phosphate once to twice daily
    Vitamin B6, Vitamin B12, and Folic Acid
    ×
    Vitamin B12 has demonstrated neuroprotective and analgesic effects and has been found to have benefits in treating peripheral neuropathy from various causes.15,16,17,18 Vitamin B12 deficiency is common in people with type 2 diabetes, and a widely used anti-diabetes medication, metformin, has been found to induce vitamin B12 deficiency.19,20,21 Vitamin B12 deficiency has been associated in some, but not all, studies with increased risk of diabetic neuropathy.22,23,24 A possible link between low folate levels and diabetic neuropathy has also been reported.23 Preliminary trials using combinations of active forms of oral vitamin B12, folate, and vitamin B6 found they have a positive effect on diabetic neuropathy symptoms and quality of life.26,27,28 In a comparison trial, vitamin B12 injections were found to be more effective than the pain medication, nortriptyline, for reducing diabetic neuropathy symptoms.29 One meta-analysis of 17 clinical trials found the combination of intramuscular or intravenous vitamin B12 plus intravenous alpha-lipoic acid may be more effective than vitamin B12 alone.30 The possible role of vitamin B12 and other B vitamins in preventing or treating chemotherapy-induced neuropathy is suggested by laboratory and animal research, but findings from human trials have not been conclusive.31,32

  • Vitamin D

    Supplementing with vitamin D3 daily or weekly can help reduce symptoms of diabetic neuropathy.

    Dose:

    7,100 IU daily or 50,000 IU weekly of vitamin D3 for eight to twelve weeks, followed by 2,000 to 4,000 IU daily long term
    Vitamin D
    ×
    Vitamin D deficiency is strongly correlated with type 2 diabetes and its complications, including neuropathy and related foot disease.32,33,34 One placebo-controlled trial with 112 participants found 50,000 IU per week (equivalent to about 7,100 IU daily) of oral vitamin D3 reduced diabetic neuropathy symptoms, but not disability or nerve dysfunction, after eight weeks of treatment.35 However, using a very high infrequent dose may not be as effective: in a preliminary uncontrolled trial, 143 subjects with diabetic neuropathy were given a single 600,000 IU injection of vitamin D and were monitored for 20 weeks; vitamin D did not relieve neuropathy symptoms but did improve neuropathy-specific quality of life scores.36 A meta-analysis of data from four randomized controlled trials found vitamin D supplementation can improve signs and symptoms of diabetic neuropathy.37 Low vitamin D levels have also been associated with increased risk of chemotherapy-induced neuropathy, but clinical trials investigating the effects of vitamin D supplementation are lacking.38,39

  • Alpha-Lipoic Acid

    Alpha-lipoic acid may reduce symptoms of diabetic peripheral neuropathy and may work best in combination with medical treatment for neuropathy. Its possible benefit in chemotherapy-induced neuropathy needs further investigation.

    Dose:

    600 to 1,200 mg daily
    Alpha-Lipoic Acid
    ×

    Several controlled trials have found intravenous alpha-lipoic acid can reduce symptoms of diabetic peripheral neuropathy; however, the effect of oral alpha-lipoic acid is still unclear. Preliminary research has suggested the benefits of supplementing with oral alpha-lipoic acid may be too small to be meaningful, yet one uncontrolled trial found 600 mg of lipoic acid daily for 40 days relieved symptoms and improved quality of life in people with painful diabetic peripheral neuropathy.40,41 Other clinical trials have shown alpha-lipoic acid may enhance the efficacy of conventional therapies. A meta-analysis of 20 studies with a combined total of 1,894 subjects with diabetic neuropathy found epalrestat plus alpha-lipoic acid was more effective for reducing symptoms and improving nerve function than either therapy alone.42 Other meta-analyses have had similar findings.43,44

    In a placebo-controlled trial that included data from 70 cancer patients being treated with cisplatin or oxaliplatin, taking 600 mg of lipoic acid three times daily for 24 weeks had no impact on neuropathy.45 A preliminary trial in multiple myeloma patients being treated with bortezomib, a combination of 600 mg alpha-lipoic acid plus 400 mg of docosahexaenoic acid (DHA), 60 mg of vitamin C, and 10 mg (15 IU) of vitamin E twice daily for six months appeared to prevent the onset and worsening of neuropathic pain.46 More research is needed to determine whether alpha-lipoic acid can protect nerves against damage induced by certain chemotherapy agents.

  • Coenzyme Q10

    There is little evidence that coenzyme Q10 improves nerve function and eases symptoms of diabetic neuropathy.

    Dose:

    400 mg daily
    Coenzyme Q10
    ×
    In a placebo-controlled trial that included 49 people with type 2 diabetes and neuropathy, those receiving 400 mg of coenzyme Q10 (CoQ10 or ubiquinone) daily for 12 weeks experienced a 50% reduction in symptoms as well as improved nerve function, but a similar trial that used a 200 mg daily dose of CoQ10 found no benefit on diabetic neuropathy symptoms.47,48

  • Vitamin E

    Vitamin E supplementation may protect against diabetes- and chemotherapy-related neuropathy.

    Dose:

    300 to 600 mg (450 to 900 IU) daily
    Vitamin E
    ×

    In a randomized controlled trial with 92 participants, adding vitamin E to usual medical care for diabetes led to reduced neuropathic pain after 12 weeks. In an uncontrolled pilot trial, 400 mg (about 600 IU) daily of vitamin E, together with 500–1,000 mg of evening primrose oil, for three months relieved pain due to diabetic neuropathy in 88% of participants; those with severe neuropathy were less likely to benefit from vitamin E plus evening primrose oil.49 However, in 300 patients with diabetes and neuropathy, 400 mg of mixed tocotrienols daily for one year had no impact on neuropathy symptoms or nerve function compared to placebo.50

    Vitamin E has demonstrated mixed effects in treating chemotherapy-induced neuropathy. In one placebo-controlled trial, 300 mg (about 450 IU) of vitamin E for three months, beginning after initiation of cancer treatment with paclitaxel, reduced the incidence of neuropathy.51 Meta-analysis of randomized controlled trials have indicated vitamin E, at doses ranging from 300 to 600 mg (450 to 900 IU) daily, may protect against chemotherapy-induced neuropathy specifically in cancer patients being treated with cisplatin.52,53 However, vitamin E does not appear to protect against neuropathy caused by the related chemotherapeutic drug, oxiplatin.54,55

  • Biotin

    There is anecdotal evidence that high-dose biotin may reduce pain from diabetic nerve damage.

    Dose:

    Refer to label instructions
    Biotin
    ×
    Researchers reported three cases of diabetic neuropathy in which high-dose biotin for four to eight weeks was effective for reducing symptoms, and biotin was continued safely for one to two years.56

  • N-Acetyl Cysteine

    A small body of evidence suggests N-acetyl cysteine may help prevent neuropathy.

    Dose:

    1,200 mg daily
    N-Acetyl Cysteine
    ×
    N-acetyl cysteine (NAC) is a precursor to one of the body’s most important antioxidants, glutathione. A small body of evidence suggests NAC may be helpful in preventing peripheral neuropathy. In a placebo-controlled trial with 90 participants with type 2 diabetes and neuropathy, adding 600 mg of NAC twice daily to usual pain medication for eight weeks led to reduced pain scores and better sleep.57 Another placebo-controlled trial that included 14 colon cancer patients found 1,200 mg daily of NAC reduced the incidence of oxiplatin-induced neuropathy after 12 chemotherapy cycles.58

  • Omega-3 Fatty Acids

    Preliminary evidence suggests omega-3 fatty acids from fish oil may help to prevent diabetes- and chemotherapy-related neuropathy.

    Dose:

    1,200 to 1,800 mg daily of omega-3 fatty acids from fish oil
    Omega-3 Fatty Acids
    ×
    A pilot study with 26 participants with type 2 diabetes and neuropathy found supplementing with omega-3 fatty acids from fish oil (1,000 mg of docosahexaenoic acid [DHA] plus 200 mg of eicosapentaenoic acid [EPA]) daily for three months reduced pain.59 Another preliminary trial reported a positive effect of 1,800 mg of EPA daily for 48 weeks on neuropathy symptoms and signs of other diabetes complications in people with type 2 diabetes.60 In a placebo-controlled trial with breast cancer patients, supplementing with omega-3 fatty acids from fish oil, at a dose of 640 mg three times daily, reduced the incidence of paclitaxel-induced neuropathy.61
What Are Star Ratings
×
Reliable and relatively consistent scientific data showing a substantial health benefit.
Contradictory, insufficient, or preliminary studies suggesting a health benefit or minimal health benefit.
For an herb, supported by traditional use but minimal or no scientific evidence. For a supplement, little scientific support.

References

1. 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) 2019;10:929.

2. Zajaczkowska R, Kocot-Kepska M, Leppert W, et al. Mechanisms of Chemotherapy-Induced Peripheral Neuropathy. Int J Mol Sci 2019;20.

3. Steps to Prevent or Delay Nerve Damage. American Diabetes Association [cited 2013 Nov 17]. Available from URL: www.diabetes.org/living-with-diabetes/complications/neuropathy/steps-to-prevent-or-delay.html.

4. Peripheral Neuropathy Fact Sheet. National Institute of Neurological Disorders and Stroke [cited 2013 Nov 17]. Available from URL: www.ninds.nih.gov/disorders/peripheralneuropathy/detail_peripheralneuropathy.htm.

5. Di Stefano G, Di Lionardo A, Galosi E, et al. Acetyl-L-carnitine in painful peripheral neuropathy: a systematic review. J Pain Res 2019;12:1341–51.

6. Dinicola S, Fuso A, Cucina A, et al. Natural products - alpha-lipoic acid and acetyl-L-carnitine - in the treatment of chemotherapy-induced peripheral neuropathy. Eur Rev Med Pharmacol Sci 2018;22:4739–54.

7. Sun Y, Shu Y, Liu B, et al. A prospective study to evaluate the efficacy and safety of oral acetyl-L-carnitine for the treatment of chemotherapy-induced peripheral neuropathy. Exp Ther Med 2016;12:4017–24.

8. Hershman D, Unger J, Crew K, et al. Two-Year Trends of Taxane-Induced Neuropathy in Women Enrolled in a Randomized Trial of Acetyl-L-Carnitine (SWOG S0715). J Natl Cancer Inst 2018;110:669–76.

9. Zhang Q, Ji L, Zheng H, et al. Low serum phosphate and magnesium levels are associated with peripheral neuropathy in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2018;146:1–7.

10. Zhang Y, Li Q, Xin Y, et al. Association between serum magnesium and common complications of diabetes mellitus. Technol Health Care 2018;26:379–87.

11. Joy S, George T, Siddiqui K. Low magnesium level as an indicator of poor glycemic control in type 2 diabetic patients with complications. Diabetes Metab Syndr 2019;13:1303–7.

12. De Leeuw I, Engelen W, De Block C, Van Gaal L. Long term magnesium supplementation influences favourably the natural evolution of neuropathy in Mg-depleted type 1 diabetic patients (T1dm). Magnes Res 2004;17:109–14.

13. Wesselink E, Winkels R, van Baar H, et al. Dietary Intake of Magnesium or Calcium and Chemotherapy-Induced Peripheral Neuropathy in Colorectal Cancer Patients. Nutrients 2018;10.

14. Jordan B, Jahn F, Beckmann J, et al. Calcium and Magnesium Infusions for the Prevention of Oxaliplatin-Induced Peripheral Neurotoxicity: A Systematic Review. Oncology 2016;90:299–306.

15. Zhang M, Han W, Hu S, Xu H. Methylcobalamin: a potential vitamin of pain killer. Neural Plast 2013;2013:424651.

16. Solomon L. Vitamin B12-responsive neuropathies: A case series. Nutr Neurosci 2016;19:162–8.

17. Shibuya K, Misawa S, Nasu S, et al. Safety and efficacy of intravenous ultra-high dose methylcobalamin treatment for peripheral neuropathy: a phase I/II open label clinical trial. Intern Med 2014;53:1927–31.

18. Franques J, Chiche L, De Paula A, et al. Characteristics of patients with vitamin B12-responsive neuropathy: a case series with systematic repeated electrophysiological assessment. Neurol Res 2019;41:569–76.

19. Tavares Bello C, Capitao R, Sequeira Duarte J, et al. Vitamin B12 Deficiency in Type 2 Diabetes Mellitus. Acta Med Port 2017;30:719–26.

20. Gupta K, Jain A, Rohatgi A. An observational study of vitamin b12 levels and peripheral neuropathy profile in patients of diabetes mellitus on metformin therapy. Diabetes Metab Syndr 2018;12:51–8.

21. Roy R, Ghosh K, Ghosh M, et al. Study of Vitamin B12 deficiency and peripheral neuropathy in metformin-treated early Type 2 diabetes mellitus. Indian J Endocrinol Metab 2016;20:631–7.

22. Biemans E, Hart H, Rutten G, et al. Cobalamin status and its relationship with depression, cognition and neuropathy in patients with type 2 diabetes mellitus using metformin. Acta Diabetol 2015;52:383–93.

23. Wang D, Zhai J, Liu D. Serum folate, vitamin B12 levels and diabetic peripheral neuropathy in type 2 diabetes: A meta-analysis. Mol Cell Endocrinol 2017;443:72–9.

24. Russo G, Giandalia A, Romeo E, et al. Diabetic neuropathy is not associated with homocysteine, folate, vitamin B12 levels, and MTHFR C677T mutation in type 2 diabetic outpatients taking metformin. J Endocrinol Invest 2016;39:305–14.

25. Trippe B, Barrentine L, Curole M, Tipa E. Nutritional management of patients with diabetic peripheral neuropathy with L-methylfolate-methylcobalamin-pyridoxal-5-phosphate: results of a real-world patient experience trial. Curr Med Res Opin 2016;32:219–27.

26. Jacobs A, Cheng D. Management of diabetic small-fiber neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5'-phosphate. Rev Neurol Dis 2011;8:39–47.

27. Walker M, Morris L, Cheng D. Improvement of cutaneous sensitivity in diabetic peripheral neuropathy with combination L-methylfolate, methylcobalamin, and pyridoxal 5'-phosphate. Rev Neurol Dis 2010;7:132–9.

28. Talaei A, Siavash M, Majidi H, Chehrei A. Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy. Int J Food Sci Nutr 2009;60:71–6.

29. Xu Q, Pan J, Yu J, et al. Meta-analysis of methylcobalamin alone and in combination with lipoic acid in patients with diabetic peripheral neuropathy. Diabetes Res Clin Pract 2013;101:99–105.

30. Schloss J, Colosimo M. B Vitamin Complex and Chemotherapy-Induced Peripheral Neuropathy. Curr Oncol Rep 2017;19:76.

31. Schloss J, Colosimo M, Airey C, et al. A randomised, placebo-controlled trial assessing the efficacy of an oral B group vitamin in preventing the development of chemotherapy-induced peripheral neuropathy (CIPN). Support Care Cancer 2017;25:195–204.

32. Senyigit A. The association between 25-hydroxy vitamin D deficiency and diabetic complications in patients with type 2 diabetes mellitus. Diabetes Metab Syndr 2019;13:1381–6.

33. Zhang B, Zhao W, Tu J, et al. The relationship between serum 25-hydroxyvitamin D concentration and type 2 diabetic peripheral neuropathy: A systematic review and a meta-analysis. Medicine (Baltimore) 2019;98:e18118.

34. Yammine K, Hayek F, Assi C. Is there an association between vitamin D and diabetic foot disease? A meta-analysis. Wound Repair Regen 2020;28:90–6.

35. Shehab D, Al-Jarallah K, Abdella N, et al. Prospective evaluation of the effect of short-term oral vitamin d supplementation on peripheral neuropathy in type 2 diabetes mellitus. Med Princ Pract 2015;24:250–6.

36. Alam U, Fawwad A, Shaheen F, et al. Improvement in Neuropathy Specific Quality of Life in Patients with Diabetes after Vitamin D Supplementation. J Diabetes Res 2017;2017:7928083.

37. Yammine K, Wehbe R, Assi C. A systematic review on the efficacy of vitamin D supplementation on diabetic peripheral neuropathy. Clin Nutr 2020.

38. Grim J, Ticha A, Hyspler R, et al. Selected Risk Nutritional Factors for Chemotherapy-Induced Polyneuropathy. Nutrients 2017;9.

39. Wang J, Udd K, Vidisheva A, et al. Low serum vitamin D occurs commonly among multiple myeloma patients treated with bortezomib and/or thalidomide and is associated with severe neuropathy. Support Care Cancer 2016;24:3105–10.

40. Papazafeiropoulou A, Xourgia E, Papantoniou S, et al. Effect of 3-month alpha-lipoic acid treatment on sural nerve conduction velocity and amplitude in patients with diabetic neuropathy: a pilot study. Arch Med Sci Atheroscler Dis 2019;4:e141–3.

41. Agathos E, Tentolouris A, Eleftheriadou I, et al. Effect of alpha-lipoic acid on symptoms and quality of life in patients with painful diabetic neuropathy. J Int Med Res 2018;46:1779–90.

42. Zhao M, Chen J, Chu Y, et al. Efficacy of epalrestat plus alpha-lipoic acid combination therapy versus monotherapy in patients with diabetic peripheral neuropathy: a meta-analysis of 20 randomized controlled trials. Neural Regen Res 2018;13:1087–95.

43. Wang X, Lin H, Xu S, et al. Alpha lipoic acid combined with epalrestat: a therapeutic option for patients with diabetic peripheral neuropathy. Drug Des Devel Ther 2018;12:2827–40.

44. Wang X, Lin H, Xu S, Lu Y. Lipoic Acid Combined with Epalrestat versus Lipoic Acid in Treating Diabetic Peripheral Neuropathy:A Meta-analysis. Zhongguo Yi Xue Ke Xue Yuan Xue Bao 2017;39:656–64.

45. Guo Y, Jones D, Palmer J, et al. Oral alpha-lipoic acid to prevent chemotherapy-induced peripheral neuropathy: a randomized, double-blind, placebo-controlled trial. Support Care Cancer 2014;22:1223–31.

46. Maschio M, Zarabla A, Maialetti A, et al. The Effect of Docosahexaenoic Acid and alpha-Lipoic Acid as Prevention of Bortezomib-Related Neurotoxicity in Patients with Multiple Myeloma. Integr Cancer Ther 2019:1534735419888584.

47. Hernandez-Ojeda J, Cardona-Munoz E, Roman-Pintos L, et al. The effect of ubiquinone in diabetic polyneuropathy: a randomized double-blind placebo-controlled study. J Diabetes Complications 2012;26:352–8.

48. Akbari Fakhrabadi M, Zeinali Ghotrom A, Mozaffari-Khosravi H, et al. Effect of Coenzyme Q10 on Oxidative Stress, Glycemic Control and Inflammation in Diabetic Neuropathy: A Double Blind Randomized Clinical Trial. Int J Vitam Nutr Res 2014;84:252–60.

49. Ogbera A, Ezeobi E, Unachukwu C, Oshinaike O. Treatment of diabetes mellitus-associated neuropathy with vitamin E and Eve primrose. Indian J Endocrinol Metab 2014;18:846–9.

50. Hor C, Fung W, Ang H, et al. Efficacy of Oral Mixed Tocotrienols in Diabetic Peripheral Neuropathy: A Randomized Clinical Trial. JAMA Neurol 2018;75:444–52.

51. Anoushirvani A, Poorsaadat L, Aghabozorgi R, et al. Comparison of the Effects of Omega 3 and Vitamin E on Palcitaxel-Induced Peripheral Neuropathy. Open Access Maced J Med Sci 2018;6:1857–61.

52. Huang H, He M, Liu L, Huang L. Vitamin E does not decrease the incidence of chemotherapy-induced peripheral neuropathy: a meta-analysis. Contemp Oncol (Pozn) 2016;20:237–41.

53. Eum S, Choi H, Chang M, et al. Protective effects of vitamin E on chemotherapy-induced peripheral neuropathy: a meta-analysis of randomized controlled trials. Int J Vitam Nutr Res 2013;83:101–11.

54. Afonseca S, Cruz F, Cubero Dde I, et al. Vitamin E for prevention of oxaliplatin-induced peripheral neuropathy: a pilot randomized clinical trial. Sao Paulo Med J 2013;131:35–8.

55. Salehi Z, Roayaei M. Effect of Vitamin E on Oxaliplatin-induced Peripheral Neuropathy Prevention: A Randomized Controlled Trial. Int J Prev Med 2015;6:104.

56. Koutsikos D, Agroyannis B, Tzanatos-Exarchou H. Biotin for diabetic peripheral neuropathy. Biomed Pharmacother 1990;44:511–4.

57. Heidari N, Sajedi F, Mohammadi Y, et al. Ameliorative Effects Of N-Acetylcysteine As Adjunct Therapy On Symptoms Of Painful Diabetic Neuropathy. J Pain Res 2019;12:3147–59.

58. Lin P, Lee M, Wang W, et al. N-acetylcysteine has neuroprotective effects against oxaliplatin-based adjuvant chemotherapy in colon cancer patients: preliminary data. Support Care Cancer 2006;14:484–7.

59. Duran A, Salto L, Camara J, et al. Effects of omega-3 polyunsaturated fatty-acid supplementation on neuropathic pain symptoms and sphingosine levels in Mexican Americans with type 2 diabetes. Diabetes Metab Syndr Obes 2019;12:109–20.

60. Okuda Y, Mizutani M, Ogawa M, et al. Long-term effects of eicosapentaenoic acid on diabetic peripheral neuropathy and serum lipids in patients with type II diabetes mellitus. J Diabetes Complications 1996;10:280–7.

61. Ghoreishi Z, Esfahani A, Djazayeri A, et al. Omega-3 fatty acids are protective against paclitaxel-induced peripheral neuropathy: a randomized double-blind placebo controlled trial. BMC Cancer 2012;12:355.

62. Hicks C, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep 2019;19:86.

63. Iqbal Z, Azmi S, Yadav R, et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther 2018;40:828–49.

64. Parasoglou P, Rao S, Slade J. Declining Skeletal Muscle Function in Diabetic Peripheral Neuropathy. Clin Ther 2017;39:1085–103.

65. Mirtha L, Permatahati V. The Effectiveness of Aerobic Exercise in Improving Peripheral Nerve Functions in Type 2 Diabetes Mellitus: An Evidence Based Case Report. Acta Med Indones 2018;50:82–7.

66. Nomura T, Kawae T, Kataoka H, Ikeda Y. Aging, physical activity, and diabetic complications related to loss of muscle strength in patients with type 2 diabetes. Phys Ther Res 2018;21:33–8.

67. Ahmad Sharoni S, Minhat H, Mohd Zulkefli N, Baharom A. Health education programmes to improve foot self-care practices and foot problems among older people with diabetes: a systematic review. Int J Older People Nurs 2016;11:214–39.

68. Barshes N, Sigireddi M, Wrobel J, et al. The system of care for the diabetic foot: objectives, outcomes, and opportunities. Diabet Foot Ankle 2013;4.

69. Grisold A, Callaghan B, Feldman E. Mediators of diabetic neuropathy: is hyperglycemia the only culprit? Curr Opin Endocrinol Diabetes Obes 2017;24:103–11.

70. Xia N, Morteza A, Yang F, et al. Review of the role of cigarette smoking in diabetic foot. J Diabetes Investig 2019;10:202–15.

Copyright © 2024 TraceGains, Inc. All rights reserved.

Learn more about TraceGains, the company.

The information presented by TraceGains is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. Self-treatment is not recommended for life-threatening conditions that require medical treatment under a doctor's care. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or pharmacist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires December 2024.

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