The Role of Biofactors in Diabetic Microvascular Complications

Abstract

: Microvascular complications are responsible for a major proportion of the burden associated with diabetes contributing to substantial morbidity, mortality, and healthcare costs in people with diabetes. Retinopathy, nephropathy, and neuropathy constitute the leading causes of blindness, end-stage renal disease, and lower-extremity amputations, respectively. Since the efficacy of causal therapies of diabetic microvascular complications is limited, especially in type 2 diabetes, there is an unmet need for adjunct treatments which should be effective despite ongoing hyperglycemia. Experimental studies indicate that diabetic microvascular complications can be prevented or ameliorated by various biofactors in animal models by interfering with the pathophysiology of the underlying condition. Some of the findings related to biofactors like α-lipoic acid and benfotiamine could be translated into the clinical arena and confirmed in clinical trials, especially in those focusing on diabetic polyneuropathy. Given the micronutrient nature of these compounds, their safety profile is excellent. Thus, they have the potential to favorably modify the natural history of the underlying complication, but large long-term clinical trials are required to confirm this notion. Ultimately, biofactors should expand our therapeutic armamentarium against these common, debilitating, and even life-threatening sequelae of diabetes.

Update on Treating Painful Diabetic Peripheral Neuropathy: A Review of Current US Guidelines with a Focus on the Most Recently Approved Management Options

“…144,145 Benfotiamine, a fat-soluble derivative of thiamine, acts by inhibiting the formation of advanced glycation end products, 146 thereby improving neuropathic symptoms in patients with DPN. 147,151 These nutraceuticals are well tolerated, with adverse event profiles similar to those with placebo.…”

Dietary and Nutritional Supplementation for Painful Diabetic Neuropathy: A Narrative Review

“…ALA is a naturally occurring antioxidant and it is considered the most promising nutraceutical [6]. In clinical trials, 600 mg ALA acid has been shown to improve neuropathic deficits [10].…”

“…Increased exercise and a healthy diet, according to lifestyle interventions, may delay or even facilitate nerve fibre regeneration [5]. Surprisingly, there is some promising evidence on the role of vitamins and supplements in improving therapy [6].…”

“…Nutraceuticals such as alpha-lipoic acid (ALA), vitamin B12, and acetyl-L-carnitine are being studied for their safety and efficacy in treating DN, according to the American Academy of Neurology [7]. The American Diabetes Association has acknowledged this by including a discussion of nutraceuticals in their PDN treatment mon-ograph [6]. Because they are widely available, inexpensive, and generally safe, nutraceuticals are an appealing treatment option for DN.…”

Predictive significance of joint plasma fibrinogen and urinary alpha-1 microglobulin-creatinine ratio in patients with diabetic kidney disease

“…However, microalbumin urine is not a sensitive and specific predictor for prevalence and progression of DKD, as the sensitivity and specificity of microalbuminuria for early detection of disease are limited by a number of factors: high day-to-day variability of urine albumin excretion; the phenomenon of non-albuminuric diabetic nephropathy; and presence of advanced renal pathological changes by the time microalbuminuria is clinically detectable [9]. Although some studies have revealed that many biological markers or biomarkers can reflect the presence of microvascular damage in type 2 diabetes (T2D) patients [10,11], and are associated with development of T2D [12,13], their predictive power for DKD and its progression is still limited.…”