Studying the Effect of Adding Alpha Lipoic Acid to Gabapentin to Improve Nerve Conduction Velocity and Glycemic Control of Patients with Diabetic Neuropathy (Sample of Iraqi population)

Abstract

Diabetic neuropathy (DN) is the most common chronic complication of diabetes mellitus. Hyperglycemia-induced oxidative stress induces programmed cell death of nerves, which contributes to the pathology of Diabetic neuropathy. Many clinical trials depend on supplement, in an attempt to improve neuropathy symptoms such as (pain & tingling) and patient quality of life, one of them is alpha-lipoic acid (ALA). Alpha-lipoic acid is a potent anti-inflammatory and antioxidant with insulin-mimetic activity, it has been shown to improve clinical symptoms in experimental Diabetic neuropathy and protect peripheral nerves from ischemia, in addition to stimulate the nerve growth factor and promote fiber regeneration. This study is aimed to evaluate the effect of Alpha-lipoic acid supplement as adjuvant therapy to gabapentin in patients with diabetic neuropathy, which can reflect by the improvement in nerve conduction velocity (NCV) a test was conducted to assess the severity of iabetic neuropathy and clinical symptoms. A prospective randomized- open-label interventional study for 3 months include 33 DN patients, aged (18-69) years were divided into two groups; group A include 16 patients received gabapentin 300 mg once daily at night, and group B include 17 patients received gabapentin 300 mg once daily at night plus alpha-lipoic acid 600mg once daily. Pre and post 3 months of treatment, blood samples used to measure metabolic biomarkers (FBG, HbA1c), in addition to Nerve conduction velocity. The results showed that, the intervention group produced a highly significant change in HbA1c & no significant change in FBG levels after 3months of Alpha-lipoic acid supplementation. Meanwhile, there is no significant change in HbA1c & FBG levels in patients treated with gabapentin alone. Moreover, results showed highly significant improvement (P˂0.01) in Nerve conduction velocity for two groups at the end of the study. Addition of Alpha-lipoic acid to gabapentin in diabetic neuropathy patients result to improve the glycemic control & Nerve conduction velocity. after three months of treatment.