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Alpha lipoic acid supports nerve function in elderly adults, post-hoc analysis shows


  • Post-hoc analysis of the NATHAN 1 trial (n= 460 participants)
  • Supplementation consists of ALA (600 mg/day) for 4 years
  • ALA supplementation is particularly suitable for elderly patients 


This post-hoc analysis of the NATHAN 1 trial was designed to analyze the impact of baseline factors on the efficacy of oral supplementation of alpha lipoic acid (ALA) (600 mg/day) taken for 4 years. The NATHAN 1 trial was a multi-center, randomized, double-blind, placebo-controlled trial evaluating the efficacy and safety of ALA treatment in patients with mild-to-moderate diabetic polyneuropathy. Efficacy measures were the Neuropathy Impairment Score of the lower limbs (NIS-LL), heart rate during deep breathing (HRDB), among others.

Results indicate that improvement and prevention of progression of diabetic neuropathy after 4 years of treatment with ALA (600 mg/day) were predicted by older age, normal BMI and blood pressure and higher disease burden due to CVD, diabetes, and neuropathy. Thus, optimal control of modifiable CVD risk factors such as body weight and blood pressure could help improve the efficacy of ALA, especially in older patients with higher disease burden. Separately, improvement in cardiac autonomic function was predicted by ACE inhibitor treatment, indicating that agents known to improve heart rate variability may favorably modulate the effect of ALA on cardiac autonomic function.

These findings suggest that ALA treatment may be particularly suitable for the elderly patient with a history of CVD and ACE inhibitor treatment and both more severe diabetes and neuropathy who cannot meet individualized glycemic targets.


Ziegler D, Low PA, Freeman R, Tritschler H, Vinik AI. Predictors of improvement and progression of diabetic polyneuropathy following treatment with α-lipoic acid for 4 years in the NATHAN 1 trial. J Diabetes Complications. 2016;30(2):350-6.

PMID: 26651260.