Complementary medicines in diabetes

In addition to lifestyle measures, some complementary medicines can be used in conjunction with the usual diabetic care.

Vitamin D

A recent meta-analysis showed vitamin D and calcium insufficiency negatively influence glycaemic control and combined supplementation of both nutrients may be beneficial in optimising glucose metabolism.1 

Metformin/French Lilac 

Metformin was developed from the herb French lilac (Galega officinalis). One of the main side-effects associated with long term use is vitamin B12 deficiency.2 

There is a role for testing serum B12 levels in people with diabetes taking metformin for long periods.

Alpha lipoic acid

Alpha lipoic acid is a potent antioxidant found in every cell that helps convert glucose into energy.3 

A recent five-week trial of oral alpha-lipoic acid in three different doses also demonstrated benefits, significantly improving neuropathic symptoms in diabetic patients compared with placebo.4 

Topical capsaicin

Various studies and review of the current evidence suggests topical capsaicin patches (up to 8%) may be useful in transiently reducing pain in diabetic neuropathy, although this may cause significant transient local skin and tissue irritation.5-7

Acetyl–L–Carnitine (ALC)

RCTs demonstrate supplementation of oral ALC, at least 2g daily, may play a role in the treatment of diabetic neuropathy compared with placebo.8-11

Dr Vicki Kotsirilos 

GP and Chair, RACGP-AIMA JWP

References

1.http://www.ncbi.nlm.nih.gov/pubmed?term=J%20Clin%20Endocrinol%20Metab%202007%3B92%3A2017%20%E2%80%93%2029. 

Pittas AG, Lau J, Hu F, et. al. The role of vitamin D and calcium in type 2 diabetes. A systematic review and meta-analysis. J Clin Endocrinol Metab 2007;92:2017 – 29.

2. http://www.ncbi.nlm.nih.gov/pubmed/20488910?dopt=Abstract 

de Jager J, Kooy A, Lehert P, Wulffelé MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: randomised placebo controlled trial.

BMJ 2010 May 20;340:c2181. doi: 10.1136/bmj.c2181.

3.http://www.umm.edu/altmed/articles/alpha-lipoic-000285.htm#ixzz1nelRccGJ

4.Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care. 2006;29:2365-2370.

5.http://www.ncbi.nlm.nih.gov/pubmed/22328830 

Webster LR, Peppin JF, Murphy FT, Tobias JK, Vanhove GF. Tolerability of NGX-4010, a capsaicin 8% patch, in conjunction with three topical anesthetic formulations for the treatment of neuropathic pain. J Pain Res. 2012;5:7-13. Epub 2012 Jan 20.

6. http://www.ncbi.nlm.nih.gov/pubmed/22001701 

Vorobeychik Y, Gordin V, Mao J, Chen L. Combination Therapy for Neuropathic Pain: A Review of Current Evidence. CNS 2011 Oct 13. [Epub ahead of print]

7.http://www.ncbi.nlm.nih.gov/pubmed/22247621 

Peppin JF, Majors K, Webster LR, Simpson DM, Tobias JK, Vanhove GF. Tolerability of NGX-4010, a capsaicin 8% patch for peripheral neuropathic pain. J Pain Res 2011;4:385-92. Epub 2011 Nov 14.

8.Cha YS. Effects of L-carnitine on obesity, diabetes, and as an ergogenic aid Asia Pac J Clin Nutr 2008;17(Suppl1):306 – 8.