General objective
To determine the effectiveness of a fixed dose combination of alpha lipoic acid and
vitamin B preparations in comparison with incative drug for treatment of diabetic
polyneuropathy (DPN) in people with type 2 diabetes mellitus.
Research hypothesis
There are significant improvements in mean total symptom score (TSS) and neuropathic
symptoms score (NSS) in people with diabetic polyneuropathy taking a fixed dose
combination of alpha lipoic acid and vitamin B preparations as compared to diabetic
polyneuropathy patients taking a placebo.
There are significant improvements in total symptom score (TSS) and neuropathic
symptoms score (NSS) among people with diabetic polyneuropathy taking a fixed dose
combination of alpha lipoic acid and vitamin B preparations for 12 weeks.
There are significant improvements in fasting plasma glucose, HbA1C level, fasting
lipid profile, body mass index (BMI), and diabetes quality of life in people with
diabetes taking a fixed dose combination of alpha lipoic acid and vitamin B
preparations as compared to diabetic patients taking placebo.
There are no significant differences in the safety parameters of renal function and
liver function tests among people with diabetic polyneuropathy at baseline and 12
weeks after taking a fixed dose combination of alpha lipoic acid and vitamin B
preparations.
There are significant improvements in fasting plasma glucose, HbA1C level, fasting
lipid profile, body mass index (BMI), and diabetes quality of life among diabetic
patients taking a fixed dose combination of alpha lipoic acid and vitamin B
preparations for 12 weeks.
Method of data collection
This study will be conducted after obtaining approval from the Universiti Sains Malaysia
Ethical Committee (JPeM) and will be conducted in accordance to World Medical Association
Declaration of Helsinki ethical principles for medical research involving human subjects.
Recruitment of subject
Participants will be recruited from Klinik Rawatan Keluarga and diabetes clinic Hospital
USM via convenience sampling. Potential participants will be identified from the case
notes of patients. Then, the participants will be approached individually. Those who are
willing to participate in this study will be given information regarding the study. The
participants will be screened to determine their eligibility criteria, including
performing neurological symptom score (NSS) and neuropathy disability score (NDS) to
determine diabetes polyneuropathy diagnosis. If all the inclusion and exclusion criteria
are fulfilled, informed consent will be obtained from all patients who agree to
participate in this study. The consent will be obtained by a study team that recruited
the patient. Upon consented, the participant's socio-demographic data will be collected,
and the medical record will be assessed to fill in their medical and diabetes profiles.
They will also answer the total symptoms score (TSS), and revised version of the Diabetes
Quality of Life (Rv-DQoL) questionnaire. The physical examination includes measurement of
height, weight, calculated Body Mass Index (BMI), and blood pressure during sitting will
be done. Then 6ml of fasting venous blood will be taken for measurement of HbA1c, fasting
blood glucose, renal function test, liver function test and fasting lipid profile as
baseline. All participants were advised not to consume any special supplement or other
replacement meal throughout the study.
The participants then will be randomized to either intervention or control group. The
intervention group will receive a fixed dose combination of alpha lipoic acid and vitamin
B preparations, and the control group will receive a placebo (look-alike substance that
contains no drug).
The participants will be seen 6 weeks after taking the product. During this visit, they
will be assessed for any side effects or adverse events and compliance with the product
supplied (compliance form). The total symptoms score (TSS), neurological symptom score
(NSS), a revised version of Diabetes Quality of Life (Rv-DQoL), blood pressure, weight,
height, calculated Body Mass Index (BMI) will also be measured. Another 6-week supply of
the product will be given.
Lastly, the participants will be assessed in week 12. During this visit, the same
measurement will be taken as visit 1, including answering the questionnaires. Adverse
events, blood taking, and compliance will also be assessed.
The duration for visit 1 and visit 3 (at 12 weeks) is about 50-60 minutes for each visit
since it will involve blood taking procedure. Duration for visit 2 (at 6 weeks) is about
30 minutes since it will not involve blood taking.
Intervention group: Fixed dose combination of alpha lipoic acid and vitamin B
preparations
At baseline, the intervention group will receive a fixed dose combination of alpha lipoic
acid and vitamin B preparations. This product is packaged and manufactured by BREGO Life
Sciences Sdn Bhd company with a brand name of Bionerv®. BIONERV® is the first combination
of alpha lipoic acid 300mg and vitamin B complex. Bionerv® is in oral film-coated, orange
colour, oblong shape and no marking and embossing on the tablet. Each tablet contains 4
active ingredients as follows: Alpha lipoic acid 300mg, Vitamin B12 (methylcobalamin)
500mcg, Vitamin B6 (pyridoxine) 8mg, Vitamin B1 (thiamine) 39mg. All the above
ingredients are synthetic. The shelf-life is 2 years. Storage condition is keeping in dry
place below 300oC and protecting from light and moisture. It has no bovine-gelatin
capsule. There are no precautions on drug-drug interaction, but it is not suitable for
children (<18 years). There is insufficient reliable data for pregnancy and breast
feeding. One bottle consists of 60 tablets.
This medication needs to take 2 tablets a day after a meal and need to drink more water.
In this study, the participants need to take 2 tablets once daily after breakfast. The
duration of the intervention will be 12 weeks. All participants are required to return to
the clinic in the 6th and 12th week for a post-intervention assessment.
Control group
At baseline, the control group will receive a placebo drug consisting of Croscamellose
Sodium, Microcrystalline Cellulose, Silicon Dioxide and Magnesium stearate. The placebo
was manufactured by Yanling Natural Hygiene Sdn Bhd. The formulation of the placebo
tablet is derived from the excipients used in the Bionerv tablet.
The participants need to take 2 tablets once daily after breakfast. The placebo drugs
will share the same appearance and color as intervention drug.
The duration of the intervention will be 12 weeks. All participants are required to
return to the clinic in the 6th and 12th week for a post-intervention assessment.
Follow up
There are two follow-ups during this study. 1st follow-up will be on the 6th week and 2nd
follow-up (final follow-up) will be during 12th week of the study.
During the 6th week follow-up, participants will be checked for their weight, height,
calculated Body Mass Index (BMI), TSS, NSS, RV-DQoL questionnaire, compliance, and
adverse effects.
A final visit (12th week) to the clinic will be conducted on the 12th week. During these
visits, the outcome measures will be assessed to determine the effect of the fixed-dose
combination of alpha lipoic acid and vitamin B. During this visit, the same measurement
will be taken as visit 1.