Pleiotropic Effects of Alpha-Lipoic Acid in Treatment of Diabetic Neuropathy in Patients with Type 2 Diabetes Mellitus

INTRODUCTION: Type 2 diabetes mellitus is an urgent problem due to its widespread prevalence and disability of patents in result of macro- and microvascular complications. Diabetic neuropathy (DN) considerably impairs the quality of life of patients. Use of alpha-lipoic acid (ALA) prevents the development of oxidative stress and improves oxidation of fatty acids.

AIM: To study the influence of alpha-lipoic acid on the variability of glycemia, lipid spectrum, ‘positive’ and ‘negative’ neurological symptoms in patients with DM2 and DN.

MATERIALS AND METHODS: The prospective study included 39 patients with DM2 and DN in the clinical stage: patients of group 1 (n = 20) were administered intravenous drip infusion of ALA 600 mg once a day for 2 weeks in hospital conditions followed by intake of 600 mg once a day per os for 2.5 months on an outpatient basis; patients of group 2 (n = 19) did not receive ALA preparations. In all the patients, parameters of lipid and carbohydrate metabolism were studied, pain, tactile, temperature, vibration sensitivity and muscle strength of lower extremities were evaluated.

RESULTS: In patients of group 1, after 12 weeks of using ALA, decrease in ‘positive’ symptoms in the lower legs and feet, improvement in vibration (0.6 ± 0.5 points, p = 0.0095), tactile (0.7 ± 0.6 points, p = 0.037), temperature sensitivity (0.2 ± 0.4 points, p = 0.027), and also decrease in the average value of glycemia (8.7 [7.4; 9.2] mmol/l, p = 0.0078), decrease in glycated hemoglobin with the achievement of the target value (7.5 ± 0.1%, p = 0.046) and improvement of lipid spectrum (total cholesterol — 5.9 ± 0.1 mmol/ l, p = 0.043) were recorded; low density lipoproteins — 3.6 ± 0.1 mmol/l, p = 0.0076; high density lipoproteins — 1.2 ± 0.1 mmol/l, p = 0.034).

CONCLUSION: In patients with type 2 diabetes mellitus with diabetic neuropathy in the clinical stage who received preparations of alpha-lipoic acid in complex treatment, reduction of neurologic deficit, of ‘positive’ neurologic symptoms was achieved in 12 weeks; with that, improvement of lipid spectrum and of glycemic control was found, which may be considered as pleiotropic effects associated with acceleration of mitochondrial biosynthesis.