Abstract
Development of chronic complications in type 2 diabetes mellitus (T2DM), namely cardiac automonic neuropathy (CAN), had been implicated as an independent risk factor for cardiovascular mortality. This paper presents the results obtained during the study of possible alpha-lipoic acid (ALA) impact on the state of insulin resistance (IR), the content of some pro- and anti-inflammatory factors in patients with T2DM and definite stage of CAN. Our study involved 33 persons with diagnosed T2DM and definite CAN, which were allocated to one of two groups. The control group (15 patients) received standard hypoglycemic treatment, whereas the intervention group (18 patients) received ALA 600 mg in film-coated tablets/q.d. in addition to standard therapy. Treatment period was 3 months in duration. Levels of glycated hemoglobin A1c, glucose, immunoreactive insulin (IRI), leptin, interleukin (IL) IL-6 and IL-8, high sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-alpha (TNF-alpha) in the blood were measured. TNF-alpha/IL-10 ratio and Homeostasis model assessment IR (HOMA-IR) were calculated. The significant reduction in glucose, IRI, leptin concentration and HOMA-IR parameters; decrease in the pro-inflammatory link activity, namely hs-CRP, TNF-alpha, IL-6 and IL-8 levels, TNF-alpha/IL-10 ratio, with no changes in IL-10 content after 3 months of treatment was found. The results of our study demonstrated the decrease in the pro-inflammatory link activity after treatment and allow us to consider ALA as one of the promising drug for complex treatment of definite stage of CAN in patients with T2DM.
Highlights
Cardiac autonomic neuropathy (CAN) is one of the most frequent type of autonomic neuropathy, that was defined by the Toronto consensus panel as the impairment of cardiovascular autonomic control among patients with diagnosed diabetes mellitus (DM) following the exclusion of other causes [1, 2]
This study focused on determining whether alpha-lipoic acid (ALA) has a potential impact on inflammation, glycaemic control, insulin resistance (IR) parameters in patients with definite CAN and type 2 DM (T2DM)
There were no differences between the groups in levels of preprandial blood glucose, immunoreactive insulin (IRI) concentrations and Homeostasis model assessment IR (HOMA-IR) parameters at baseline
Summary
Cardiac autonomic neuropathy (CAN) is one of the most frequent type of autonomic neuropathy, that was defined by the Toronto consensus panel as the impairment of cardiovascular autonomic control among patients with diagnosed diabetes mellitus (DM) following the exclusion of other causes [1, 2]. Victoria Serhiyenko et al.: The Impact of Alpha-Lipoic Acid on Insulin Resistance and Inflammatory Parameters in Patients with Type 2 Diabetes Mellitus and Cardiac Autonomic Neuropathy physiological antioxidants, including alpha-lipoic acid (ALA), a powerful lipophilic “trap” of free radicals, promote the prevention of neurovascular disorders, provide the basis for the pathogenetically-based application of ALA in the treatment of diabetic angio-, neuropathy, in particular including diabetic CAN. The results of Deutsche Kardiale Autonome Neurophathie (DEKAN) study demonstrated that treatment with ALA, using a well-tolerated dose of 800 mg/day orally during four months was associated with improvement of heart rate variability (HRV) parameters [8, 9]. Despite the data that ALA seems to be promising drug to improve HRV, neuropathic symptoms, trials aimed to evaluate features of ALA among patients with DM without diagnosed chronic heart diseases are few, and obtained results do not confirm its effectiveness [9, 10]. A review of many clinical trials using chronic antioxidant therapy was not able to demonstrate the benefits for cardiovascular diseases [10]
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