Painful diabetic neuropathy

Diabetic polyneuropathy (DPN) is a devastating complication of diabetes that can lead to foot ulceration, Charcot foot, amputation, severe pain, and major psychological disorders. In 2000, it was estimated that 2.8% (171 million) of the world population had diabetes mellitus, and the WHO predicts that by the year 2030, this will rise to 4.4% (366 million). The greatest increases in diabetes prevalence will be seen in the Middle East, sub-Saharan Africa, and India (1). In the United States, recent reports estimate that 23.6 million people have diabetes (2). Roughly 50% of those with diabetes will develop DPN (3,4), and it is the leading cause of foot ulcers and nontraumatic limb amputation (5). In 2003, the annual cost of diabetic neuropathy was estimated to exceed $10.9 billion (6). The rise in diabetes and hence neuropathy prevalence with the high physical and financial costs demand greater attention and focused research in prevention and treatment of this debilitating complication.