Alpha-lipoic acid — a lifeline for nerves in diabetes?

Aim of the study: Alpha-lipoic acid (ALA) was found to improve the symptoms in patients with diabetic sensorimotor peripheral neuropathy (DSPN) by reducing oxidative stress and ameliorating microcirculation. Our meta-analysis is aimed at evaluating the effects of oral-administered ALA versus a placebo in patients with DSPN and determining the optimal dosage for this treatment.

Results: ALA treatment produced favorable results for TSS (a dose-related trend was observed), NDS, and the global satisfaction score. For VAS, VPT, NIS-LL, and NCS results, ALA did not produce favorable results. ALA treatment had favorable effects on DSPN by reducing sensory symptoms, and it resulted in a dose-dependent response relative to the placebo for TSS and the global satisfaction score. The use of ALA to prevent neurological symptoms should be further researched.

Aim of the study: To evaluate the effects and safety of 300-600 mg α-lipoic acid (ALA) given i.v. for diabetic peripheral neuropathy (DPN).

Results: Fifteen randomized controlled trials met the inclusion criteria. The treatment group involved the administration of ALA 300-600 mg i.v. per day. And the control group used the same interventions except for ALA. Compared with the control group, nerve conduction velocities increased significantly in the treatment group. The weighted mean differences in nerve conduction velocities were 4.63 (95% confidence interval 3.58-5.67) for median MNCV, 3.17 (1.75-4.59) for median SNCV, 4.25 (2.78-5.72) for peroneal MNCV, and 3.65 (1.50-5.80) for peroneal SNCV in favor of the treatment group. The odds ratio in terms of efficacy was 4.03 (2.73-5.94) for ALA. Furthermore, no serious adverse events were observed during the treatment period. The results of this meta-analysis provide evidence that treatment with ALA (300-600 mg/day i.v. for 2-4 weeks) is safe and that the treatment can significantly improve both nerve conduction velocity and positive neuropathic symptoms.

Aim of the study: Neuropathy is a serious complication of diabetes. Its management focuses on glycaemic control, multifactorial cardiovascular risk intervention, pathogenesis-oriented therapy, and analgesics where needed.

Aim of the study: Diabetic neuropathy presents a major public health problem. It is defined by the symptoms and signs of peripheral nerve dysfunction in diabetic patients, in whom other causes of neuropathy have been excluded.

Results: Treatment with alpha-lipoic acid increases reduced glutathione, an important endogenous antioxidant. In clinical trials, 600 mg alpha-lipoic acid has been shown to improve neuropathic deficits. This review focuses on the relationship of alpha-lipoic acid and auto-oxidative glycosylation. It discusses the impact of alpha-lipoic acid on hyperglycemia-induced oxidative stress, and examines the role of alpha-lipoic acid in preventing glycation process and nerve hypoxia.

Aim of the study: Diabetic peripheral neuropathy (DPN) is found in around one third of people with diabetes, but remains inadequately diagnosed and treated. Its management includes three cornerstones: 1) causal treatment with lifestyle modification, intensive diabetes therapy aimed at near-normoglycemia, and multifactorial cardiovascular risk intervention, 2) pathogenesis-oriented pharmacotherapy, and 3) symptomatic pain relief.

Results: Efficacy and excellent safety were demonstrated in several meta-analyses (α-lipoic acid) and randomized clinical trials (benfotiamine, actovegin, epalrestat) in the treatment of symptomatic DPN. The NATHAN 1 trial demonstrated an improvement of neuropathic signs (deficits, impairments) after four years in asymptomatic DPN. These compounds are currently authorized for treatment of DPN in several countries. Long-term pivotal clinical trials should further establish their value as mono- and combination therapies in DPN.

Aim of the study: In this article, we perform a systematic review and meta-analysis evaluating the effects of alpha-lipoic acid (ALA) supplementation on biochemical, clinical, inflammatory, and functional parameters in patients with diabetic polyneuropathy or diabetic peripheral neuropathy (DPN). A total of 15 articles were included, of which 12 were analyzed for outcomes.

Results: A systematic search across multiple databases was conducted using keywords, such as "diabetes mellitus," "diabetes mellitus type I," "diabetes mellitus type II," "alpha-lipoic acid," and "ALA supplementation." A total of 15 studies met the inclusion criteria. Of the 23 outcomes analyzed, 19 showed significant differences in favor of alpha-lipoic acid (ALA) supplementation at different doses versus a placebo or other treatments. Notable improvements were observed in Total Symptom Score (TSS) paresthesia (SMD = -1.04; 95 % CI = -1.24 to -0.84; p < 0.00001), TSS numbness (SMD = -0.23; 95 % CI = -0.44 to -0.01; p = 0.04), and the Hamburg Pain Adjective List (HPAL) (SMD = -1.00; 95 % CI = -1.15 to -0.85; p < 0.00001), among others. These improvements were particularly evident for symptoms, such as paresthesia, numbness, and burning sensations, especially at a dose of 600 mg/day.