The Journal of clinical endocrinology and metabolism
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J. Clin. Endocrinol. Metab. · Aug 2005
ReviewCLINICAL REVIEW: Use of antiepileptic drugs in the treatment of chronic painful diabetic neuropathy.
Up to 25% of individuals with diabetes develop painful diabetic neuropathy, suffering spontaneous pain, allodynia, hyperalgesia, and other unpleasant symptoms. Decreased physical activity, increased fatigue, and mood and sleep problems may result. ⋯ The most important aspect of treatment is targeted at modification of the underlying disease. However, approaches to symptomatic pain control are essential and include multiple drug classes. Tricyclic antidepressants, including imipramine, nortriptyline, and amitriptyline, have been the mainstays of treatment, but anticholinergic effects, such as dry mouth, blurring of vision, constipation, orthostatic hypotension, and cardiac arrhythmias, as well as other adverse effects, often limit their use. Other treatments include capsaicin, clonidine, acupuncture, and electrical stimulation, suggesting that there is no single effective treatment. First-generation antiepileptic drugs have been shown to be effective in neuropathic pain. The evidence supporting the use of a new generation of antiepileptic drugs in painful diabetic neuropathy is reviewed.
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J. Clin. Endocrinol. Metab. · Aug 2005
Defining the proinflammatory phenotype using high sensitive C-reactive protein levels as the biomarker.
Inflammation is pivotal in atherosclerosis. The prototypic marker of inflammation is C-reactive protein (CRP). Numerous studies have confirmed that high CRP levels in normal volunteers predict cardiovascular events. ⋯ A phenotype characterized by increased plasma inflammatory mediators as well as increased LPS-stimulated whole blood TNF-alpha and IL-1beta levels is associated with high plasma CRP levels. This systemic inflammatory phenotype may contribute to vascular inflammation or may reflect inflammation in vessels or at other sites.