Summary & conclusion
Our study is an opened cross sectional study which was carried out on 50 patients with type 2 DM who have cardiovascular autonomic neuropathy and/or symptomatic polyneuropathy, who were attending the outpatient endocrine clinic at Benha university hospital. Five patients didn’t continue the study because they didn’t tolerate the drug, and 45 patients completed the study.
The inclusions criteria :
All patients with Type 2 Diabetes Mellitus who have cardiovascular autonomic neuropathy and/or symptomatic polyneuropathy.
The exclusion criteria:
1. Type 1 diabetic patients.
2. The patients who have other causes of P.N e.g: Hypothyroidism ,CKD, chronic liver diseases, malignancy.
3. Patients on medication which might affect the outcome of P.N :
a) medication causing neuropathic pain e.g : corticosteroid.
b) medication aimed at reliefing neuropathic pain e.g: vitamen B12 complex.
For all studied cases after giving their informed consent , the following was done :
1. Thorough history and clinical examination was performed to all patients with special stress on the following :
• Duration of DM.
• Type of the treatment.
• BMI ,Waist –hip ratio
• manifestation of peripheral neuropathy (sensory & motor).
• CVS manifestation of autonomic neuropathy.
• Other manifestations of autonomic neuropathy.
2. Laboratory tests:
• TSH , AST ,ALT, s.creatinine , bl.urea.
• HDL cholesterol , LDL cholesterol.
All patients received α-lipoic acid in a dose of 1800mg oral/day for a minimum of 12 weeks.
At the start and at the end of the study the following tests were performed to every patient :
Assessment of DPN:
DPN status was evaluated by four methods:
1. Self-reported numbness of the lower limbs.
2. Monofilament test.
3. Vibration perception threshold (VPT), and ankle reflexes.
4. Nerve conduction studies.
Assessment of cardiovascular autonomic neuropathy:
Tests for cardiac parasympathetic & sympathetic action
Our study exploring the efficacy of oral ALA not only on symtoms , signs and electrophysiological parameters of DSPN ,but also on symptoms and signs on cardiovascular autonomic neuropathy.
The results of the study showing the following:
• Nearly eighty two percent of study group had positive sensorimotor manifestations of polyneuropathy ,while 17.8% of patients were negative.
• Nearly eighty two percent of patients were positive for monofilament test, while 17.8% were negative.
• Nearly sixty four percent of study group had positive nerve conduction studies , while 35.6% of patients were negative.
• Nearly seventy percent of study group were positive for cardiovascular autonomic neuropathy tests, while 31.1% were negative.
• Mean HbA1c was significantly higher in those with positive sensorimotor manifestations of polyneuropathy (7.3) ,compared to those with negative sensorimotor manifestations of polyneuropathy (6.8).
• Mean HbA1c was significantly higher in those with positive nerve conduction studies results (7.3), compared with those had negative results (6.9).
• Mean BMI was significantly higher in patients with positive cardiovascular autonomic neuropathy tests (29.2), compared with those had negative results (26.8).
• Mean HDL cholesterol in females was significantly higher in those with negative cardiovascular autonomic neuropathy tests (68), compared with those of positive cardiovascular autonomic tests (63).
• The duration of DM & age of patient had no significant influence on the following:
I. patients with positive and negative sensorimotor manifestations of polyneuropathy.
II. Patients with positive and negative nerve conduction studies results.
III. Patients with positive and negative cardiovascular autonomic tests.
• Alpha-lipoic acid (ALA) in a dose of 1800mg oral/day for a minimum of 12 weeks had significant positive impact on diabetic polyneuropathy & cardiovascular autonomic neuropathy.
• State of glycemic control had a significant positive impact on diabetic polyneuropathy.
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