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Grbović Vesna
12/2013Dissertation
A randomized prospective clinical experiment was conducted over two parallel groups of patients who suffer from diabetes mellitus, type 2 and with the diagnosis of distal symmetric sensorimotor polyneuropathy (DSMP). The goal of the study is to research and compare the effects of physical procedures and of the treatment with alpha lipoic acid. The study involved two groups of 30 patients each suffering from diabetes mellitus, type 2, and with the diagnosis of DSMP set on the basis of clinical symptoms and signs, as well as on the basis of electromioneurography (EMNG) parameters. The first group (group A) of patients was treated by physical therapy, and the second group (group B) with alpha lipoic acid. According to methodology, the study was conducted during three diagnostic and therapeutic cycles, each of which lasted 16 days, while the period of time between two cycles was 6±1 weeks (total duration of the research was six months). During this period, the patients in the group A were treated with an identical combination of physical agents during 14 days: with pulsed electromagnetic field (PEMF), transcutaneous electrical nerve stimulation (TENS), stable galvanization (SG) and kinesitherapy (KTH). During the physical therapy the electro therapy procedures and magnet therapy were applied first, while the kinesitherapy was applied at the end. In the group B, alpha lipoic acid was used in compliance with the medication producer’s recommendations and the standard clinical practice. During ospitalization, the patients were treated with intravenous infusion of alpha lipoic acid (600mg in 500ml 0,9% NaCl) in the conditions protected from light, 90 minutes per day, during 14 days in the time interval from 08hrs to 10hrs. After the period of hospitalization and during the whole period of the research, the patients continued to regularly take 600mg of alpha lipoic acid perorally (one tablet per day, in the morning before breakfast). The results show that in treatment of distal symmetric diabetes polyneuropathy both therapy methods that were under research (physical therapy and use of alpha lipoic acid) have positive effects in terms of pain reduction, improvement of quality of life, improvement of electromioneurography results for peripheral nerves and strengthening of leg muscles. The therapy by combined physical procedures has better effect on pain reduction and muscle strengthening, while on the other hand the use of alpha lipoic acid has additional positive effect on biochemical parameters for regulation of glucose and lipids. Sprovedeno je randomizovano eksperimentalno kliničko prospektivno istraživanje, u dve paralelne grupe ispitanika koji boluju od dijabetes melitusa tip 2 i kod kojih je postavljena dijagnoza distalne simetrične dijabetesne senzomotorne polineuropatije (DSMP) u cilju da se ispita i uporedi efekat fizikalnih procedura i tretmana alfalipoičnom kiselinom. U studiju su bile uključene dve grupe od po 30 pacijenata obolelih od dijabetes melitusa tip 2, kod kojih je na osnovu kliničkih simptoma i znakova, kao i parametara elektromioneurografskog (EMNG) nalaza postavljena dijagnoza DSMP. Prva grupa (grupa A) ispitanika je tretirana fizikalnom terapijom, a kod druge grupe ispitanika (grupa B) je bila primenjena alfalipoična kiselina. Protokol studije je podrazumevao da je studija sprovedena tokom tri dijagnostičko-terapijska ciklusa, svaki od njih je trajao 16 dana, a vremenski period između dva ciklusa je bio 6±1 nedelja (ukupno trajanje studije je šest meseci). U Grupi A, u ovom periodu, pacijenti su lečeni identičnom kombinacijom fizikalnih agenasa tokom 14 dana: pulsirajućim elektromagnetnim poljem (PEMP), transkutanom električnom neuralnom stimulacijom (TENS), stabilnom galvanizacijom (SG) i kineziterapijom (KTH). Prilikom primene fizikalne terapije prvo su se sprovele elektroterapijske procedure i magnetoterapija (nije bitan redosled sprovođenja terapija), a na kraju je sprovedena kineziterapija. U Grupi B je primenjena alfalipoična kiselina u skladu sa preporukom proizvođača leka i standardnom kliničkom praksom. Tokom hospitalizacije pacijenti su lečeni intravenskom aplikacijom preparata alfalipoične kiseline (600 mg u 500 ml 0,9% NaCl). Aplikacija se odvijala u uslovima zaštite od svetla, tokom 90 minuta, u vidu intravenske infuzije, svakodnevno, tokom 14 dana u vremenskom periodu od 08:00 do 10:00. Po završenoj hospitalizaciji, a tokom celog perioda studije, ovi ispitanici su nastavljali da redovno uzimaju peroralno preparat alfalipoične kiseline u dozi od 600 mg (jedna tableta dnevno, ujutru pre doručka). Pokazano je da u lečenju distalne simetrične dijabetesne polineuropatije oba ispitivana terapijska modaliteta (fizikalna terapija i primena alfalipočne kiseline) imaju koristan efekat u smislu redukcije bola, poboljšanja kvaliteta života, poboljšanja elektromioneurografskog nalaza perifernih nerava i poboljšanja mišićne snage muskulature donjih ekstremiteta. Terapija kombinovanim fizikalnim procedurama ima izrazitiji efekat na redukciju bola i povećanje mišićne snage, dok primena alfalipoične kiseline je imala dodatni koristan efekat na biohemijske parametre glikoregulacije i liporegulacije.
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