Why are there no good treatments for diabetic neuropathy?

Diabetic neuropathy is a global problem affecting about half of the 366 million people with diabetes worldwide. The condition can lead to debilitating painful neuropathy in about 20% of patients with diabetes. 1 Tesfaye S Boulton AJ Dickenson AH Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. Diabetes Care. 2013; 36: 2456-2465 Crossref PubMed Scopus (204) Google Scholar Diabetes itself increases the relative risk of foot ulceration and amputation by more than 23 times, 2 Holman N Young RJ Jeffcoate WJ Variation in the recorded incidence of amputation of the lower limb in England. Diabetologia. 2012; 55: 1919-1925 Crossref PubMed Scopus (164) Google Scholar and diabetic neuropathy independently predicts all-cause mortality (hazard ratio [HR] 4·4) and diabetes-related mortality (HR 11·82). 3 Hsu WC Chiu SY Yen AM et al. Somatic neuropathy is an independent predictor of all- and diabetes-related mortality in type 2 diabetic patients: a population-based 5-year follow-up study (KCIS No. 29). Eur J Neurol. 2012; 19: 1192-1198 Crossref PubMed Scopus (29) Google Scholar