Complex therapy of diabetic polyneuropathy taking into account endothelial dysfunction in patients with type 2 diabetes mellitus

• Olga P. P'yanykh
• Anyuta A. Kosyan
• Mayya A. Garieva

Abstract

The aim of the study is to assess the functional state of the endothelium in patients with type 2 diabetes after complex therapy with drugs of alpha-lipoic acid, vitamin B ₁₂, cocarboxylase, ATP and nicotinamide.

Material and methods. The study involved 24 patients aged 45-70 years with a diagnosis of type 2 diabetes with distal sensorimotor diabetic polyneuropathy. Patients were divided into 2 groups based on the speed of pulse wave propagation (PWV) of the arteries of the upper extremities: 1^st group with physiological values of PWV (n=12), 2^nd group - with increased PWV (n=12). All patients were prescribed complex therapy for 10 days with a 6-month interval (alpha lipoic acid, cocarboxylase, triphosphadenine disodium trihydrate, cyanocobalamin, nicotinamide).

Results and discussion. At the start of the study, the groups were comparable in terms of the main indicators. Before therapy, a decrease in the level of SOD and a tendency toward a decrease in the level of GPO were observed in 2 ^nd group compared with 1^st group. The level of HC was higher than the reference values and positively correlated with the values of PWV (r=0.6; p<0.05) in 2^nd group. In addition, in 2^nd group the TSS values were significantly higher and there was a negative correlation between the values of PWV and TSS (r= -0.4; p<0.05).

After therapy, in both groups there was an increase in the levels of GPO and active vitamin B ₁₂, as well as an improvement in the functional state of the peripheral nervous system according to the NIS-LL scale and ENMG data. In 2^nd group, normalization of PWV indicators and a decrease in the level of HC were observed.

Conclusion. The combined use of antioxidants and neurotropic drugs, leading to increased levels of antioxidant enzymes and active vitamin B ₁₂, as well as to a decrease in homocysteine levels, helps to improve the function of the endothelium and peripheral nervous system.

Keywords:type 2 diabetes mellitus, diabetic neuropathy, endothelial function, vitamin B12 , antioxidants

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