A Case for Alpha-Lipoic Acid as an Alternative Treatment for Diabetic Polyneuropathy

Abstract

-Purpose: The aim of this systematic review is to evaluate current evidence of alpha-lipoic acid (ALA) regarding efficacy, safety, and cost to accurately compare it with other diabetic polyneuropathy (DPN) treatments. The intention is to provide recommendations on future research and to promote utilization of ALA in the United States (US). Methods: A literature search was conducted on three databases: Scopus, PubMed, and Web of Science. The following criteria were used to select studies: (1) randomized controlled trials (RCTs) and open-label trials on ALA, (2) review articles and meta-analyses of RCTs on ALA, (3) study population consisting of patients with diabetes mellitus, peripheral neuropathic pain, and/or metabolic syndrome. Results: Twenty-five publications were selected including five RCTs and three open-label studies. Most clinical trials were conducted outside of the US. Current data provides evidence for the benefits of ALA in DPN treatment at a dose of 600 mg per day, either intravenously (IV) or orally, for a duration of at least 3 weeks with minimal side effects. Conclusions: ALA demonstrates effectiveness in treating DPN through multiple mechanisms to modulate pathophysiology and control symptoms. In addition, ALA exhibits activity in weight management and insulin sensitivity. The use of ALA for DPN in the US is worth considering because commonly prescribed medications have unclear mechanisms, more pronounced adverse effects, and are more expensive than ALA. Further research needs to be conducted to assess long-term efficacy of ALA in US patients. __________________________________________________________________________________________

Evaluating the Efficacy of the Treatment with Benfotiamine and Alpha-lipoic Acid in Distal Symmetric Painful Diabetic Polyneuropathy

“…Our study proved that the greatest improvement regarding DNS score, NDS and the pain intensity on the visual analogue scale was achieved in the group of patients that were given Benfotiamine and ALA treatment. The most important observation in the medical literature is that ALA acts not only on the mechanisms that maintain and lead to the progression of DSPDN, but also improves the symptoms, meaning that it plays a double role of pathogenic and symptomatic treatment [40].…”

Current concepts in the management of diabetic polyneuropathy

“…Collectively, these trials show that intravenous a-lipoic acid (600 mg/ day) improved neuropathic symptoms and signs after 3 weeks. Furthermore, oral treatment for 5 weeks (600 mg/day) ameliorated pain, paresthesia and numbness at a clinically important level 22,31,32,[41][42][43][44][45][46][47][48] . In the Neurological Assessment of Thioctic Acid in Diabetic Neuropathy ( NATHAN ) 1 trial, including 460 participants with diabetes and mild-to-moderate largely asymptomatic DSPN, neuropathic deficits were improved with a-lipoic acid after 4 years 32,41,47 .…”

Mitoprotective Clinical Strategies in Type 2 Diabetes and Fanconi Anemia Patients: Suggestions for Clinical Management of Mitochondrial Dysfunction

“…In view of the recognized roles of MNs in mitochondrial functions, a body of literature has focused on the beneficial outcomes of treating diabetic patients with each MN, leading to clinical improvements following patients' treatment with ALA, or coQ10, or CARN, as summarized in Table 1 (reviewed in [7]). Since early clinical studies in the 1990s, ALA has been demonstrated to provide adjuvant support in ameliorating the clinical conditions of T2D patients [34][35][36][37][38][39][40][41][42][43][44][45][46][47][48], with the recognition of ALA as a prescription drug in diabetic patients by the German Drug Index [49]. Other clinical studies have investigated the adjuvant effects of either coQ10 [50][51][52][53][54][55] or CARN (or acyl-CARN) [56][57][58][59][60][61][62][63][64][65] in T2D patients, by improving blood pressure and glycemic control.…”