Department of Physiology, College of Medicine, University of the Philippines Manila, Manila, Philippines; Department of Epidemiology and Biostatistics, College of Public Health, University of the Philippines Manila, Manila, Philippines.
Department of Internal Medicine, Medical Center Manila, Manila, Philippines.
Can J Diabetes. 2024 Jun;48(4):233-243.e10. doi: 10.1016/j.jcjd.2024.01.007. Epub 2024 Jan 29.
Current medications for diabetic neuropathy (DN) recommended by the American Diabetes Association and American Academy of Neurology do not address the pathologic process of denervation among patients with DN, because ancillary treatments, such as reactive oxygen scavengers, may be needed. The purpose of this work was to summarize the available evidence about the efficacy and safety of alpha lipoic acid (ALA) and gamma linolenic acid (GLA) in the management of DN.
Using the search terms [(alpha lipoic acid or ALA or thioctic acid or thioctacid) or (gamma linolenic acid or GLA)] AND [(diabetes or diabetes mellitus) AND (polyneuropathy or neuropathy or sensorimotor polyneuropathy or radiculopathy)], 11 studies were included in this review and combined meta-analysis.
Eight of the 11 articles (73%) reported significant benefit of ALA vs placebo. In the meta-analysis, the Total Symptom Score (TSS) for ALA 600 mg/day (ALA600) was 1.05 points lower (standard mean difference [SMD] -1.05, 95% confidence interval [CI] -2.07 to -0.04, p=0.04, I=98.18%) compared with control at the end of the study. In the network meta-analysis, ALA600 (SMD -1.68, 95% CI -2.8 to -0.6) and GLA (SMD -2.39, 95% CI -4.3 to -0.5) had significantly lower TSSs compared with placebo. Moreover, GLA had the highest probability of being the best (52.7%) for improving DN symptoms. In all studies, most adverse events include gastrointestinal disturbances. In terms of tolerability, no differences were detected between ALA and control groups.
ALA and GLA appear to be safe and efficacious biofactors for improvement of DN symptoms.
美国糖尿病协会和美国神经病学学会推荐的目前用于治疗糖尿病性神经病变 (DN) 的药物并不能解决患有 DN 的患者的去神经病变病理过程，因为可能需要辅助治疗，如活性氧清除剂。这项工作的目的是总结关于 α-硫辛酸 (ALA) 和 γ-亚麻酸 (GLA) 在治疗 DN 中的疗效和安全性的现有证据。
使用搜索词 [(α-硫辛酸或 ALA 或硫辛酸或硫辛酸) 或 (γ-亚麻酸或 GLA)] 和 [(糖尿病或糖尿病) 和 (多发性神经病或神经病或感觉运动多发性神经病或神经根病)]，纳入了这篇综述和综合荟萃分析的 11 项研究。
11 篇文章中的 8 篇 (73%) 报告了 ALA 与安慰剂相比的显著益处。在荟萃分析中，ALA 600mg/天 (ALA600) 的总症状评分 (TSS) 低 1.05 分 (标准均数差 [SMD] -1.05，95%置信区间 [CI] -2.07 至 -0.04，p=0.04，I=98.18%) 与研究结束时的对照组相比。在网络荟萃分析中，ALA600 (SMD -1.68，95%CI -2.8 至 -0.6) 和 GLA (SMD -2.39，95%CI -4.3 至 -0.5) 的 TSS 明显低于安慰剂。此外，GLA 改善 DN 症状的最佳可能性最高 (52.7%)。在所有研究中，大多数不良事件包括胃肠道紊乱。在耐受性方面，ALA 和对照组之间没有差异。
ALA 和 GLA 似乎是安全有效的生物因子，可改善 DN 症状。
