Verbesserung der Glucoseverwertung bei Patienten mit Typ-II-Diabetes mellitus unter α-Liponsaure (Thioctsaure)

Thioctic acid, also known as alpha lipoic acid (ALA), a naturally occuring compound, is frequently used for the treatment of diabetic polyneuropathy and was shown to be a safe and reliable drug. Experimental studies revealed enhanced glucose transport and utilization in different animal models. Therefore, it was of interest to investigate whether ALA is also capable to stimulate glucose disposal in clinical conditions of reduced insulin sensitivity, such as NIDDM. A case report supported the hypothesis, and pilot studies were initiated, in which well controlled Type 2 diabetics received ALA (1.000 mg/500 ml NaCl; or vehicle only) during a hyperinsulinemic glucose-clamp (placebo controlled study) or 500 ml ALA/d over 10 d in an open uncontrolled study. While the acute administration of vehicle had no significant effect on insulin sensitivity (MCR1 3,6 ± 0,21 vs. MCR2 4,01 ± 0,19 ml/kg/min), the infusion of ALA resulted in a marked increase of glucose disposal by about 50% (MCR1 3,91 ± 0,6 vs. MCR2 5,89 ± 0,8 ml/kg/min, p ≤ 0,05, Wilcoxon-Rank-Sumtest). The ten day treatment of type II diabetics with ALA enhanced insulin-stimulated whole body glucose disposal by about 30% (MCR1 2,47 ± 0,28 vs. MCR2 3,15 ± 0,35 ml/kg/min, p ≤ 0,05, Wilcoxon-Rank-Sumtest). Meanwhile other groups have confirmed these observations. In conclusion, the present data indicate that parenteral administration of thioctic acid enhances insulin-stimulated glucose disposal in NIDDM. Animal studies suggest that the compound increases insulin-stimulated glucose transport activity, non-oxidative glucose disposal and glucose oxidation in peripheral tissues, such as skeletal muscle.