N. Ninashvili, K. Tchaava, N. Gegeshidze, Nia Shavdia

Background:  Diabetic peripheral neuropathy (DPN) is a common and severe complication that affects 50% of people with diabetes. The amino acid acetyl-L-carnitine (ALC) plays a role in the transfer of long-chain fatty acids into mitochondria for β-oxidation (1). Data on treatment of DPN with ALC support its use (2).  ALC is as effective as MC in improving clinical symptoms and neurophysiological parameters for patients with diabetic peripheral neuropathy over a 24-week period with good tolerance (3). Further studies, in particular, randomized control trials with a cohort study design are required to determine the effectiveness of ALC.

Goal and Objectives: The study aimed to determine efficacy of Acetyl-L-Carnitine in Diabetic-2 patients with peripheral neuropathic pain.

Methods: 46 Diabetic 2 patients with peripheral neuropathic pain were enrolled in the observational study. Patients were divided into two groups: the first group was composed of - 21 patient and the second group - of 25 patients. Both groups of patients received standard therapy, while the second group was additionally given Acetyl-L-Carnitine 1000 mg 3 times a day for 6 months. Pain was assessed by the visual analogue scale (VAS) at the beginning and at the end of the observation. In order to determine the sensitivity and severity of sensorimotor polyneuropathy, a standard neurological examination was performed with the calculation of the severity of sensory and motor deficits according to the NIS-LL scale.  Biochemical tests for HbA1c and lipid range) were performed at the beginning and at the end of the observation.

Results:  The study results showed: in the first group, initially, the average intensity of neuropathic symptoms according to VAS was 6.2 ± 2.6 points. After treatment-5,5±2,4 points. In the second group -before treatment   6.5 ± 2.6 points and after -3,8±2,1. The greatest effect of Acetyl-L-Carnitine was noted for aching pains, tingling, burning and shooting pains in both groups, however a positive correlation between pain relief and positive dynamics of glycated hemoglobin was observed in the second group. In the first group level of HbA1c was reduced from  8,5±1,6 to 7,5±1,8%, in the second group - from 8,4±1,7% to 7,2±1,5%. 

Conclusion: The study findings showed positive dynamics of different neuropathic pains by using Acetyl-L-Carnitine.

Kay words: Diabetic neuropathic pain, Acetyl-L-Carnitine
REFERENCES:

1.     Rolim LC, da Silva EM, Flumignan RL, Abreu MM, Dib SA. Acetyl-L-carnitine for the treatment of diabetic peripheral neuropathy. Cochrane Database Syst Rev. 2019 Jun 15;6(6):CD011265. doi: 10.1002/14651858.CD011265.pub2. PMID: 31201734; PMCID: PMC6953387.

2.     Evans JD, Jacobs TF, Evans EW. Role of Acetyl-L-Carnitine in the Treatment of Diabetic Peripheral Neuropathy. Annals of Pharmacotherapy. 2008;42(11):1686-1691. doi:10.1345/aph.1L201. 

3.     Sheyu Li, Xiang Chen, Qianrui Li, Juan Du, Zhimin Liu, Yongde Peng, Mian Xu, Qifu Li, Minxiang Lei, Changjiang Wang, Shaoxiong Zheng, Xiaojuan Zhang, Hongling Yu, Jinyu Shi, Shibing Tao, Ping Feng, Haoming Tian.  Effects of acetyl-L-carnitine and methylcobalamin for diabetic peripheral neuropathy: A multicenter, randomized, double-blind, controlled trial. JDI. September 2016. Volume7, Issue5. Pages 777-785.