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1 pdpn early screening and management The Hidden Faces of Diabetes Summit was held in Johannesburg, South Africa, from 20 to 21 September Organized by Pfizer Middle East and Africa, the interactive and innovative scientific forum consisting of plenary sessions and case studies discussed current developments and shared evidence, experience and research into the management of neuropathic pain. The meeting was attended by more than 100 delegates from 5 countries from South Africa. The meeting brought together several renowned international and regional speakers from different countries and specialties. The meeting was focused on hidden face of diabetes, which is cardiovascular end-points related with diabetic dyslipidemia, neuropatic pain and diabetic peripheral neuropathy. Dear Doctor, We appreciate your participation and thank you for your attendance and contribution to the Hidden Faces of Diabetes Summit. We would like to share with you the key highlights from this meeting and hope that you enjoy reading the newsletter. Thank you once again!

2 Hidden faces of diabetes Dr. Raal highlighted that diabetes mellitus has reached epidemic proportions and It is estimated that there are more than 360 million people with diabetes worldwide, and this is expected to increase to around 500 million by the year Every year 7 million people develop diabetes and 4 million die from complications of the disease. Cardiovascular risk factors were common; 25% had diabetes, 43% had hypertension, 68% had abdominal obesity and dyslipidaemia was present in 70%. Although much lower than that in middle eastern countries (30-47%), diabetes was common among South African patients, with a prevalence of 23%. Dr. Raal informed that type 2 diabetes is commonly regarded as a lifestyle disease. Associated risk factors are well known and include abdominal fat distribution, overweight and obesity, lack of exercise and unhealthy dietary choices. By reviewing the results of multi-center clinical studies, Dr. Raal emphasized, in contrast to the pharmacological management of other cardiovascular risk factors, the use of statins to reduce cholesterol in patients with type 2 diabetes has been shown to translate into favourable cardiovascular outcomes. Prof. Frederick Raal

3 Diabetes Mellitus and Diabetic Peripheral Neuropathic Pain Dr. Jacovides drew attention to the other co-morbidity of diabetes mellitus; diabetic peripheral neuropathy (DPN). DPN is one of the most common complications associated with diabetes mellitus, occurring in up to 50% of patients. It is associated with significant morbidity and mortality and increased costs of health care. Up to 11% of patients with DPN may also experience DPN-associated pain (DPNP). DPNP does not respond to conventional analgesics, such as nonsteroidal anti-inflammatories and may be difficult to treat. It can significantly interfere with sleep and daytime activities and adversely affects quality of life. However, until recently, very little research has been performed in South Africa to determine the prevalence of DPNP. Dr. Jacovides added that both sleep and health-related quality of life were significantly and adversely affected by neuropathic pain and medications used in an attempt to control pain were frequently inappropriate. He recommended screening patients with diabetes for DPNP at diagnosis and at least annually thereafter using simple clinical tests is important for early detection. The DN4 is an easy to use, validated screening tool that can be widely used in general practice. Early detection and appropriate treatment, using medications with proven efficacy, are important for improving the quality of life in patients with DPNP. Dr. Andrew Jacovides

4 Underreported Diabetic Peripheral Neuropathy Dr. Malik reviewed, the diabetic peripheral neuropathy (DPN) is a common complication in patients with diabetes. Dr. Malik emphasized, in contrast to the other microvascular complications, retinopathy and nephropathy, it frequently goes unrecognised, underreported by patients and undertreated by doctors. He confessed that once neuropathy is present, however, currently there are no treatments that can reverse or modify the progression of nerve fibre destruction, but he said, the aim of therapy for DPNP, therefore, should provide symptom relief. Dr. Malik talked about treatment also. He mentioned there are a lot of different drugs are used throughout the world to treat neuropathic pain, including tricyclic antidepressants, selective serotonin reuptake inhibitors (SSRIs), serotonin norepinephrine reuptake inhibitors (SNRIs), anticonvulsants, opioid analgesics and topical preparations, including capsaicin and lignocaine. Of these, only duloxetine (an SNRI), gabapentin and pregabalin (anticonvulsants) are approved by the FDA for this indication. Prof. Rayaz Malik

5 Dr. Gérard Mick Treatment of Painful Diabetic Neuropathy Dr. Mick defined the neuropathic pain. He accepted that glycaemic control and lifestyle modification are the cornerstone of management for type 2 diabetes, but as he highlighted, once DPNP has developed these interventions do not modify the progression of pain and pain will progressively worsen over time. He talked about specific molecules that have been shown to be efficacious in relieving symptoms of DPNP include gabapentanoids (pregabalin and gabapentin), tricyclic antidepressants (TCA; amitriptyline and nortriptyline) and serotonin noradrenaline reuptake inhibitors (SNRIs; duloxetine and venlafaxine). He concluded, the effective treatment of DPNP requires a detailed knowledge of the pharmacological alternatives.

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