The Role of Daily Phosphodiesterase 5 Inhibitors in the Management of Diabetic Neuropathy-The Importance of a Multidisciplinary Approach.

This paper explores the common pathological links between diabetic neuropathy (DN), affecting over 50% of men with type 2 diabetes mellitus and erectile dysfunction (ED) affecting approximately 75%. Current guidelines for DN only consider drugs to modify neurological pain pathways without influencing the underlying pathologies. By blocking pain pathways, most of these drugs can adversely affect ED and sexual function but these issues are rarely discussed in clinics where the relief of pain is considered as paramount. Because of the close overlap of vascular and neurological processes involved in DN and ED, and their high prevalence, this paper investigates the evidence for chronic dosing with phosphodiesterase 5 inhibitors. These drugs have established benefits for endothelial dysfunction, glucose metabolism and nerve regeneration, thus treating the underlying processes rather than simply blocking pain fibres. Because of the high prevalence of DN and ED, perhaps the time has come for early prevention rather than waiting for the development of intractable symptoms that are often poorly responsive to conventional treatments.