“Several guidelines offer additional levels of evidence regarding the efficacy of various other agents such as tricyclic antidepressants, gabapentin and more, but clinicians should consider the presence of comorbidities and possible drug interactions when selecting specific agents.”

She noted that none of these agents have any effect on the nerve fiber damage, however, and they are only used to manage the pain. 

“We don’t have agents that address the mechanism of the disease. We are treating other risk factors. There is evidence to date suggesting that exercise and diet are able to prevent and reverse nerve damage. There are several clinical trials that have looked at diet and exercise and show improvement in both symptoms and more objective measures. Some small studies have shown that the damage can be prevented and ever reversed in prediabetics,” Busui said.

Martin Myers, MD, who is a diabetes specialist and a professor of internal medicine at the University of Michigan, agrees with Busui. He said there is a vital need to diagnose peripheral neuropathy in patients with prediabetes earlier in the course of the disease. 

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Additionally, Myers said lifestyle interventions might lead to significant improvements in neuropathic pain.

“Prediabetes is getting to be a bigger and bigger problem and, as a consequence, there are more people with this pain syndrome,” Myers said in an interview. “The treatment is the same for diabetics and prediabetics. None of the treatments are going to give them their feeling back. They are going to treat the pain from neuropathy.”

However, in the future, that may change. He said advances in the understanding of what happens to nerve fibers in patients with prediabetes may lead to new treatments that can slow the cascade of events that culminate in peripheral neuropathy in both people with diabetes and those with prediabetes.


  1. Diabetes Latest: More than 29 million adults have diabetes; 1 in 4 doesn’t know. Centers for Disease Control and Prevention website. http://www.cdc.gov/features/diabetesfactsheet. June 17, 2014. Accessed June 2015.
  2. Lee C et al. Diabetes Care. 2015;38(5):793-800.
  3. Smith GA et al. Diabetes Care. 2006;29(6):1294-1299.