Mike: Hello, I'm Mike Clarke, podcast editor for the Cochrane Library. Alpha-lipoic acid is sometimes used for the treatment of diabetic peripheral neuropathy. In this podcast, one of the authors, Caterina Delcea, talks with lead author Cristian Baicus, consultant in internal medicine from Colentina University Hospital Bucharest in Romania, about the January 2024 Cochrane review of this treatment.

Caterina: Dr. Baicus, could you start by explaining what diabetic neuropathy is and the possible benefits of alpha-lipoic acid?

Cristian: Of course. Diabetic neuropathy is one of the complications that can occur for patients with diabetes. It's a type of nerve damage and causes pain. Alpha-lipoic acid, or ALA, which is a naturally occurring compound, is thought to improve the symptoms by protecting nerve cells from damage. It's been researched for its potential to alleviate pain, numbness, and the general discomfort associated with this condition.

Caterina: I know that diabetic peripheral neuropathy affects many individuals worldwide. Why focus this review on alpha-lipoic acid?

Cristian: Indeed, the condition is a prevalent issue, and while treatments are available, not all patients find relief with these. Therefore, when we noticed a growing interest in alpha-lipoic acid due to its antioxidant properties, we wanted to assess its effectiveness and safety thoroughly in order to guide healthcare decisions.

Caterina: What outcomes were evaluated, and what did the review find regarding the efficacy of ALA in managing neuropathy symptoms?

Cristian: We included three trials with a total of 816 participants to assess long-term effectiveness because, considering its presumed mechanism of action, ALA's effect should appear only after a few months. We were interested in all outcomes important for patients, like the change in neuropathy symptoms expressed as changes in the Total Symptom Score, impairment, quality of life, complications of the diabetic peripheral neuropathy, and adverse events. Unfortunately, however, our findings suggest that alpha-lipoic acid likely has little to no effect on neuropathy symptoms or impairments over six months or more.

Caterina: What about the quality of the three studies?

Cristian: They had a high risk of bias, particularly regarding participant attrition, which challenges the reliability of these findings. This is an important reminder of the need for more stringent research if the findings are to be good enough to inform practice.

Caterina: What about safety?

Cristian: The review shows that ALA is generally well-tolerated by most patients, with only minor side effects reported, such as skin rashes or digestive issues.

Caterina: In view of all those insights, what would you recommend to our listeners?

Cristian: I'd have to say that while alpha-lipoic acid shows promise in theory, its practical benefits for diabetic neuropathy are not yet confirmed. I'd recommended that patients should consult healthcare providers and consider all treatment options.

Caterina: Thanks, dr. Baicus. If people would like to read the review, how can they find it?

Cristian: It's available online. If they visit Cochrane Library dot com and type "alpha-lipoic acid" in the search box, they'll see the link near the top of the list.