Evaluating the add-on effect of alpha-lipoic acid to metformin on insulin-sensitivity markers in women with gestational diabetes
DOI:
https://doi.org/10.55629/pakjpathol.v35i4.869Abstract
Objective: To evaluate the add-on effect of alpha-lipoic acid to metformin therapy on insulin-sensitivity markers in women with gestational diabetes mellitus (GDM).
Materials and Methods: This quasi-experimental study was conducted from September 2023 to June 2024 at the outpatient clinic of the Department of Gynecology and Obstetrics and the Department of Pathology, Quaid-e-Azam Medical College, Bahawalpur, Pakistan. They were assigned to groups to receive metformin plus either 600 mg/day alpha-lipoic acid (ALA) or placebo for 8 weeks. The primary outcome of this study was the absolute change in homeostatic model assessment for insulin resistance (HOMA-IR) from baseline to a period after the 8th week. Secondary outcomes included changes in fasting glucose plasma levels, fasting insulin, and quantitative insulin sensitivity check index (QUICKI). Data was analyzed using ANCOVA and linear mixed-effects models, adjusting for baseline values and BMI.
Results: A total of 142 participants completed the study trial (Placebo = 70; ALA = 72). The ALA group showed a fair but statistically significant reduction in HOMA-IR at 8 weeks compared to placebo (adjusted mean difference: –0.26; 95% CI: –0.46 to –0.06; FDR-adjusted p = 0.024). Improvements were also observed in fasting glucose (–3.2 mg/dL), fasting insulin (–1.12 µU/mL), and QUICKI (+0.005), all favoring the ALA group.
Conclusion: ALA supplementation improved insulin-sensitivity markers when added to metformin in patients with GDM, although the magnitude of improvement was modest. Further research is needed to assess long-term metabolic benefits, maternity and newborn outcomes, and safety during pregnancy.
Keywords: Alpha-lipoic acid, gestational diabetes mellitus, HOMA-IR, insulin resistance, quasi-experimental study, QUICKI
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