Tocotrienol-Rich Vitamin E (Tocovid) Improved Nerve Conduction Velocity in Type 2 Diabetes Mellitus Patients in a Phase II Double-Blind, Randomized Controlled Clinical Trial

Health Benefits of Palm Tocotrienol-Rich Fraction: A Systematic Review of Randomized Controlled Trials

CONTEXT

Vitamin E, a well-known antioxidant with numerous positive effects on human health, encompasses tocotrienol-rich fraction (TRF), a natural variant abundant in palm oil.

OBJECTIVE

This systematic review analyzed findings from randomized controlled trials published until 2022 to evaluate the health impacts of palm TRF.

DATA SOURCES

A literature search was performed in Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, OVID Medline, SCOPUS, and Web of Science from inception until December 2022. Thirty studies involving 2646 patients, including both healthy individuals and those with underlying conditions, were identified.

RESULTS

This review shows palm TRF to be a promising natural supplement against inflammation and lipid peroxidation and that can significantly enhance overall health. Additionally, the study underscores the necessity for further research to ascertain the optimal dosage, formulation, and duration of supplementation, maximizing the potential health advantages.

CONCLUSION

This systematic review provides evidence supporting the health benefits associated with palm TRF.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42020204070.

Association between low birth weight and impaired glucose tolerance in children: a systematic review and meta-analysis

Background

A potential association between the onset of diabetes and normal birth weight (NBW) has been discovered. Diverse conclusions and study methodologies exist regarding the connection between low birth weight (LBW) and impaired glucose tolerance in children, underscoring the need for further robust research. Our institution is embarking on this study to thoroughly examine the association between LBW and impaired glucose tolerance in children.

Methods

We conducted searches on Cochrane Library, ScienceDirect, EMBASE, PubMed, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature data (CBM) online database, VIP full-text Database, and Wanfang Database to identify correlation analyses or case-control studies investigating the relationship between LBW and abnormal glucose tolerance in children. The search spanned from January 2010 to September 2023. The quality of observational studies was evaluated using the Newcastle-Ottawa Scale (NOS) tool. Data synthesis was performed using the statistical software RevMan 5.3 for meta-analysis.

Results

Based on the preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines, we finally included 10 clinical control studies consisting of a total of 2971 cases. There wasn't considerably change in blood sugar levels among LBW, NBW and high birth weight (HBW) infants (P > 0.05). There was no significant difference in insulin levels between LBW infants and NBW infants (P > 0.05). The HOMA-IR of LBW infants was considerably higher than that of NBW infants (P < 0.05). The risk of abnormal glucose tolerance in LBW infants was 0.42 times higher than that in NBW and HBW infants [Fisher's Z = 0.42, 95% CI = (0.09, 0.75), P = 0.01].

Conclusion

LBW is associated with an increased risk of abnormal glucose tolerance, as indicated by elevated HOMA-IR level in LBW infants compared to NBW and HBW pediatric population. Further research is needed to confirm and expand upon these findings to better understand the complex relationship between LBW and impaired glucose tolerance in children.

Cell metabolism pathways involved in the pathophysiological changes of diabetic peripheral neuropathy

Diabetic peripheral neuropathy is a common complication of diabetes mellitus. Elucidating the pathophysiological metabolic mechanism impels the generation of ideal therapies. However, existing limited treatments for diabetic peripheral neuropathy expose the urgent need for cell metabolism research. Given the lack of comprehensive understanding of energy metabolism changes and related signaling pathways in diabetic peripheral neuropathy, it is essential to explore energy changes and metabolic changes in diabetic peripheral neuropathy to develop suitable treatment methods. This review summarizes the pathophysiological mechanism of diabetic peripheral neuropathy from the perspective of cellular metabolism and the specific interventions for different metabolic pathways to develop effective treatment methods. Various metabolic mechanisms (e.g., polyol, hexosamine, protein kinase C pathway) are associated with diabetic peripheral neuropathy, and researchers are looking for more effective treatments through these pathways.

Vitamins in neuropathy: pathophysiological and therapeutic roles

PURPOSE OF REVIEW

Vitamin deficiency is a risk factor in the development of peripheral neuropathy, which leads to complex and severe diseases. This review provides an update overview of the literature on the roles of vitamins in peripheral neuropathy, highlighting their pathophysiological and therapeutic roles.

RECENT FINDINGS

The importance and clinical manifestations and implications of the vitamins and vitamin deficiencies are further demonstrated in peripheral neuropathy and the associated diseases. Vitamin deficiency is common in various severe and complex diseases such as diabetes, chemotherapy, acute nutritional axonal neuropathy, dermatitis, complex regional pain syndrome, postherpetic neuralgia, carpal tunnel syndrome, and so forth and some rare clinical case reports. There is evidence that deficiencies of almost all vitamins are associated with diabetic neuropathy. Vitamin supplementation may serve as an effective therapeutic strategy.

SUMMARY

The vitamins play critical roles in maintaining physiological functions, and vitamin deficiencies cause peripheral neuropathy with various severe and complex diseases. The therapeutic benefits of vitamins and further understanding of the mechanisms for vitamin treatment effects should be emphasized and highlighted. More clinical trials are needed to establish optimal treatment strategies for vitamins in the various neuropathies. A large range of people/patients screening for vitamin deficiencies may be considered in order to provide early diagnosis and timely medical assistance.

Effects of Tocotrienol-Rich Fraction Supplementation in Patients with Type 2 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

There are a large number of studies that have reported benefits of tocotrienol-rich fraction (TRF) in various populations with different health status. To date, no systematic reviews have examined randomized controlled trials (RCTs) on the effect of TRF supplementations specifically in patients with type 2 diabetes mellitus (T2DM). This systematic review and meta-analysis aim to examine the changes in HbA1c (glycated hemoglobin), blood pressure, and serum Hs-CRP (C-reactive protein high sensitivity) levels at post-TRF supplementation. Online databases including PubMed, Scopus, OVID Medline, and Cochrane Central Register of Controlled Trials were searched from inception until March 2023 for RCTs supplementing TRF in patients with T2DM. A total of 10 studies were included in the meta-analysis to estimate the pooled effect size. The Cochrane Risk-of-Bias (RoB) Assessment Tool was utilized to evaluate the RoB in individual studies. The meta-analysis revealed that TRF supplementation at a dosage of 250-400 mg significantly decreased HbA1c (-0.23, 95% CI: -0.44, -0.02, P < 0.05, n = 754), particularly where the intervention duration is less than 6 mo (-0.47%, 95% CI: -0.90, -0.05, P < 0.05, n = 126) and where duration of diabetes is less than 10 y (-0.37, 95% CI: -0.68, -0.07, P < 0.05, n = 83). There was no significant reduction in systolic and diastolic blood pressure and serum Hs-CRP (P > 0.05). The present meta-analysis demonstrated that supplementing with TRF in patients with T2DM decreased HbA1c but does not decrease systolic and diastolic blood pressure and serum Hs-CRP.

A novel approach to alpha-lipoic acid therapy in the treatment of diabetic peripheral neuropathy

Diabetic peripheral neuropathy (DPN) is a heterogenic disorder prevalent amongst patients suffering from diabetes mellitus (DM), with symptoms comprising neuropathic pain, paresthesia, and numbness in distal lower limbs. Alpha-lipoic acid (ALA) is proposed as a pathogenesis-oriented treatment option, targeting underlying causes of neural lesions such as hyperglycemia, metabolic and microvascular dysfunctions, and cellular oxidative stress. We performed a comprehensive review of controlled clinical trials demonstrating the clinical usefulness of ALA in the treatment of DPN, published in the last 5 years to determine the benefits of ALA monotherapy and combined treatments with other known antioxidants. We also investigated the differential efficacy of oral versus intravenous ALA administration. Clinical trials show the efficacy of ALA treatment, attributed to its anti-inflammatory, anti-hyperglycemic, and antioxidant properties, as well as its function in the endothelial activation and lipid metabolism parameters. ALA supplementation is associated with amelioration in nerve conduction velocity scores, clinically significant reduction of reported neuropathic pain, burning and paresthesia, as well as a decrease in serum triglycerides, improved insulin sensitivity, and quality of life.

A Retrospective Study on the Time in Range of Blood Glucose and Type 2 Diabetic Peripheral Neuropathy

Background

Time in range (TIR) is one of the basic indicators to assess glycemic control. In this study, the TIR of DPN patients was used as the observation index to further evaluate the correlation between TIR and DPN, so as to provide new ideas for preventing the occurrence of DPN and delaying its disease progression.

Methods

A total of 120 patients with T2DM (T2DM) who were hospitalized in the Endocrinology Department of our hospital from October 2018 to February 2020 were included and divided into two groups according to whether the nerve conduction velocity was normal or not, the diabetic peripheral neuropathy group (DPN) and the other groups. No diabetic peripheral neuropathy group (NDPN). According to the corresponding inclusion and exclusion criteria, the baseline data were recorded, and test indicators such as homocysteine and blood lipids were collected at the same time, and TIR was collected by a transient blood glucose meter. To explore the relationship between TIR and other indicators and peripheral neuropathy in T2DM.

Results

A total of 120 T2DM patients participated in the study, including 82 in the DPN group and 38 in the NDPN group. There were no statistically significant differences in basic indicators such as age, height, and weight between the two groups. Glycated hemoglobin (HbA1c) and homocysteine (Hcy) in DPN group were higher than those in NDPN group, while TIR and HDL-C were lower than those in NDPN group (P < 0.05). Logistic regression analysis showed that HbA1c and Hcy were risk factors for DPN, and TIR and HDL-C were protective factors for DPN, with statistical significance (P < 0.05). The prediction results of TIR, Hcy, HDL-C, and HbA1c on diabetic peripheral neuropathy were analyzed by ROC curve, and the prediction results of the five variables were all statistically significant (P < 0.05) and have a better prediction effect.

Conclusion

(1) The results of TIR level suggest that the longer the blood sugar is in the good control range, the more beneficial it is to reduce the occurrence of DPN. (2) TIR and HDL-C are protective factors for DPN, and HbA1c and Hcy are risk factors for DPN. (3) The results of ROC curve analysis showed that TIR, Hcy, HbA1c, and HDL-C had a good predictive effect on the occurrence of DPN.