Tags

Type your tag names separated by a space and hit enter

Aldose reductase inhibitors for the treatment of diabetic polyneuropathy

Evidence Summaries

Level of Evidence = C

Aldose reductase inhibitors may not be effective in the treatment of diabetic polyneuropathy.

A Cochrane review 1 (abstract , review ) included 29 trials assessing the primary outcome, change in neurological function with aldose reductase inhibitors (either sorbinil, tolrestat, ponalrestat, zopolrestat, zenarestat, epalrestat, ranirestat, or fidarestat). Sufficient data for meta-analysis were only available in 13 studies (n=1,788). There was no overall significant difference between the treated and control groups (SMD –0.25, 95% CI –0.56 to 0.05), although one subgroup analysis (four trials using tolrestat) favored treatment. A benefit for neuropathic symptoms was suggested by a group of trials using a dichotomized endpoint (improvement or not), but this was contradicted by another group of trials which measured symptoms on a continuous scale. There was no overall benefit on nerve conduction parameters (27 studies) or foot ulceration (one study). Quality of life was not assessed in any of the studies. While most adverse events were infrequent and minor, three compounds had dose limiting adverse events that lead to their withdrawal from human use: severe hypersensitivity reactions with sorbinil, elevation of creatinine with zenarestat, and alteration of liver function with tolrestat.

Comment: The quality of evidence is downgraded by limitations in study quality, by inconsistency (heterogeneity in interventions and outcomes) and by potential reporting bias.

References

1. Chalk C, Benstead TJ, Moore F. Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Cochrane Database Syst Rev 2007 Oct 17;(4):CD004572.  [PMID:17943821]


Copyright © 2017 Duodecim Medical Publications Limited.
Aldose reductase inhibitors for the treatment of diabetic polyneuropathy is a sample topic from the Evidence-Based Medicine Guidelines.

To view other topics, please or purchase a subscription.

Evidence Central is an integrated web and mobile solution that helps clinicians quickly answer etiology, diagnosis, treatment, and prognosis questions using the latest evidence-based research. Learn more.

Citation

"Aldose Reductase Inhibitors for the Treatment of Diabetic Polyneuropathy." Evidence-Based Medicine Guidelines, Duodecim Medical Publications Limited, 2019. Evidence Central, evidence.unboundmedicine.com/evidence/view/EBMG/453016/all/Aldose_reductase_inhibitors_for_the_treatment_of_diabetic_polyneuropathy.
Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. https://evidence.unboundmedicine.com/evidence/view/EBMG/453016/all/Aldose_reductase_inhibitors_for_the_treatment_of_diabetic_polyneuropathy. Accessed August 21, 2019.
Aldose reductase inhibitors for the treatment of diabetic polyneuropathy. (2019). In Evidence-Based Medicine Guidelines. Available from https://evidence.unboundmedicine.com/evidence/view/EBMG/453016/all/Aldose_reductase_inhibitors_for_the_treatment_of_diabetic_polyneuropathy
Aldose Reductase Inhibitors for the Treatment of Diabetic Polyneuropathy [Internet]. In: Evidence-Based Medicine Guidelines. Duodecim Medical Publications Limited; 2019. [cited 2019 August 21]. Available from: https://evidence.unboundmedicine.com/evidence/view/EBMG/453016/all/Aldose_reductase_inhibitors_for_the_treatment_of_diabetic_polyneuropathy.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Aldose reductase inhibitors for the treatment of diabetic polyneuropathy ID - 453016 BT - Evidence-Based Medicine Guidelines UR - https://evidence.unboundmedicine.com/evidence/view/EBMG/453016/all/Aldose_reductase_inhibitors_for_the_treatment_of_diabetic_polyneuropathy PB - Duodecim Medical Publications Limited DB - Evidence Central DP - Unbound Medicine ER -