Effect of acetyl-l-carnitine in the treatment of diabetic peripheral neuropathy: A systematic review and meta-analysis - 07/04/17

Doi : 10.1016/j.eurger.2017.01.002

N. Veronese ^a,^⁎ , G. Sergi ^a, B. Stubbs ^b,^c,^d,
the EUGMS special interest group on diabetes
I. Bourdel-Marchasson ^e,^f, D. Tessier ^g, C. Sieber ^h, T. Strandberg ^i,^j, S. Gillain ^k, M. Barbagallo ^l, G. Crepaldi ^m, S. Maggi ^m, E. Manzato ^a
^a University of Padova, department of medicine, geriatrics section, via Giustiniani, 2, 35128 Padova, Italy
^b Physiotherapy department, South London and Maudsley National Health Service Foundation Trust, London, United Kingdom
^c Health service and population research department, institute of psychiatry, psychology and neuroscience, King's College London, London, United Kingdom
^d Faculty of health, social care and education, Anglia Ruskin university, Chelmsford, United Kingdom
^e Clinical gerontology department, CHU de Bordeaux, 33000 Bordeaux, France
^f RMSB, UMR 5536, CNRS, 33400 Bordeaux, France
^g Geriatric division, Sherbrooke university, Quebec, Canada
^h Institute for biomedicine of aging, Friedrich-Alexander-Universität Erlangen-Nürnberg, Nuremberg, Germany
ⁱ Geriatric clinic, department of medicine, university of Helsinki, Helsinki, Finland
^j Institute of health sciences/geriatrics, university of Oulu, Oulu university hospital, Oulu, Finland
^k Service de gériatrie, CHU de Liège, Liège, Belgium
^l Geriatric unit, department of internal medicine and geriatrics, university of Palermo, Palermo, Italy
^m National research council, aging branch neuroscience institute, Padova, Italy

^⁎Corresponding author. Tel.: +00390498218492; fax: +00390498211218.

Abstract

Background/aim

Deficiency of acetyl-L-carnitine (ALC) and L-carnitine (LC) appears to play a role in peripheral diabetic neuropathy, although the evidence in humans is still limited. We conducted a systematic review and meta-analysis investigating the effect of ALC on pain and electromyographic parameters in people with diabetic neuropathy.

Methods

A literature search in major databases, without language restriction, was undertaken. Eligible studies were randomized controlled trials (RCTs) or pre- and post-test studies. The effect of ALC supplementation on pain perception and electromyographic parameters in patients with diabetic neuropathy was compared vs. a control group (RCTs). The effect of ALC/LC on electromyographic parameters were also calculated vs. baseline values. Standardized mean differences (SMD) and 95% confidence intervals (CIs) were used for summarizing outcomes.

Results

Six articles, with a total of 711 diabetic participants, were included. Three RCTs (340 treated with ALC vs. 203 placebo and 115 with methylcobalamine) showed that ALC reduces pain perception (SMD=−0.45; 95% CI: −0.86 to −0.04; P=0.03; I²=85%). Compared to controls, ALC supplementation improved nerve conduction velocity and amplitude response for ulnar nerve (both sensory and motor component). Compared to baseline values, ALC/LC supplementation improved nerve conduction velocity for all the sensory and motor nerves (except ulnar and peroneal) investigated and the amplitude of all nerves. The onset of adverse events was generally limited to minor side effects.

Conclusion

ALC appears to be effective in reducing pain due to diabetic neuropathy compared to active or placebo controls and improving electromyographic parameters in these patients.

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Keywords : Acetyl-L-carnitine, Neuropathy, Diabetes, Meta-analysis