Glyceryl Trinitrate Patches as an Alternative to Isosorbide Dinitrate Spray in the Treatment of Chronic Painful Diabetic Neuropathy

In the October 2002 issue of Diabetes Care , we reported (1) the benefit of isosorbide dinitrate (ISDN) in the treatment of painful diabetic neuropathy. This stance was based on the speculation that the impaired nitric oxide (NO) generation might play a role in the pathogenesis of neuropathic pain through defects in local vasodilatation. This was a double-blind, randomized, placebo-controlled, two-period, crossover design study of 22 diabetic patients. The ISDN spray reduced overall neuropathic pain ( P = 0.02) and burning sensation ( P = 0.006). Fifty percent of the patients reported improvement in their quality of life and wanted to continue the ISDN spray. Since then, this publication has received considerable interest, with numerous inquiries from clinicians and …