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Bissinger R, Artunc F, Qadri SM, Lang F

Eating balanced meals and snacks throughout the day reduces the chance of these blood sugar crashes and subsequent cravings followed by blood sugar spikes

The review is completed in a way that is systematic, highly rigorous, and transparent in order to minimize bias

We critically appraise this evidence and highlight key translational constraints: very low oral bioavailability and poor intestinal permeability, extensive presystemic biotransformation (microbiome-mediated hydrolysis and CYP-mediated metabolism) with unresolved active species (parent PF versus metabolites), and limited DPN-relevant pharmacokinetics, particularly the lack of peripheral nerve/DRG exposure measurements aligned with pharmacodynamic endpoints

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