Effect Of Alpha-lipoic Acid On Type2Diabetic Patients With Abdominal Obesity And Erectile Dysfunction

Recently,especially since China reformed and opened for more30years.whih people’s standard of living improved and life style changed,the incidence of diabetes mellitus of type2(T2DM) and obesity (especially abdominal obesity) has increased rapidly.At present.the disease rate of T2DM in adults of China has reached9.7%.According to the disease rate,the number of T2DM in adults of China has reached9.2million,and China has been a big diabetic country in the world.The chronic complications of diabetes threaten people’s health severely and has become a severe common problem of the society.How to prevent and cure the chronic complications of diabetes effectively has great practical significance.Erectile dysfunction (ED) is a common chronic complication in male T2DM patients,and its incidence is3times that of non-diabetec people.According to the concept of National institute of hygienics(NIH),if the erectile rigidity can not make penis insert vagina enough.or its maintained time can not make penis accomplish sexual intercourse enough and occurrence rate is more than50%,the patient will be diagnosed to be with ED.The diabetic mellitus ED(DMED) rate has reached30%～75%in diabetic patients.There have been different theories explaning the mechanism of chronic diabetic complications for many years,the oxidative stress(OS) is the "common soil" of chronic diabetic complications.There is consanquineous relation among hyperglycemia,OS and chronic diabetic complications.OS is more severe in T2DM patients with abdominal obesity.OS can result in abnormity of pancreatic beta-cell function and insulin resistence(IR)(the both are the main character of T2DM),but also,OS and the damage of endothelium function resulting from OS play an important role in occurrence and development of DMED.So,if the state of OS is improved,whether the pancreatic beda-cell function and the endothelium function can be improved?whether the improvement can help to cure DMED?which should be selected among the numerous antioxidants?Alpha-lipoic acid (LA) is an inartificial antioxidant and is used to cure DMED,but,so far,there has not a study in which LA is used to cure T2DM patients with ED and abdominal obesity and to observe the effects of LA on those patients’pancreatic beta-cell function、OS、endothelium and ED yet.IN view of this,we carry out this study.Objectives:1.Clinical and serum data from30T2DM patients with ED and abdominal obesity(abdominal obesity group, AO group) and30T2DM patients with ED but without abdominal obesity(non-abdominal obesity group, NAO group) were studied.The difference of pancreatic beta-cell function、OS、endothelium function、 erectile function between the two groups and the relationship of the difference with OS were statistically analyzed.2. Clinical and serum data from AO group and NAO group before and after the application of LA were studied. The difference of pancreatic beta-cell function、OS、 endothelium function、erectile function between before LA application and after LA application in each group and the relationship of the difference with LA application were statistically analyzed.3. Clinical and serum data from AO group and NAO group after the application of LA were studied. The difference of changed extent in pancreatic beta-cell function、 OS、endothelium function、erectile function between the two groups and the relationship of the difference with abdominal obesity were statistically analyzed.Methods:1.30cases from AO group and30cases from NAO group participated in the trials. Firstly,all patients in both groups received intensive treatments:no smoking,no drinking, and their blood glucose、blood lipid、blood pressure were controlled well. Secondly.both groups were treated with alpha-lipoic acid intravenously600mg dose daily for3weeks.2.Before and after the application of LA, the beta-cell function parameters[insulin sensitivity index(ISI)、the mean area under the curve(AUC) of insulin when an oral glucose tolerance test(OGTT) was performed],the oxidative stress parameters [superoxide dismutase (SOD)、glutathion peroxidase (GSH-Px)、 melonaldehyde (MDA)] and endothelial function parameters [nitric oxide (NO)、 endothelin-1(ET-1)、brachial artery flow-mediated endothelium-dependent dilation and glyceryltrinitrate-mediated endothelium-independent dilation measured with high resolution ultrasound]of all cases from the both groups were measured. The International Index of Erectile Function5(IIEF-5) was also used to appraise the status and severity of erectile dysfunction before and after the application of LA.3.The differences of those parameters between the two groups and between before and after LA application were statistically analyzed.Results:1. Before the alpha-lipoic acid treatment, in abdominal obesity group, AUC、ISI、 SOD、GSH-Px、NO、score of IIEF-5and flow-mediated endothelium-dependent dilation were lower and MDA、ET-1were higher than those in non-abdominal obesity group (P<0.05),there were no significant difference in glyceryltrinitrate-mediated endothelium-independent dilation between2groups (P>0.05)2. After the alpha-lipoic acid treatment, AUC、ISI、SOD、GSH-Px、NO、score of IIEF-5and flow-mediated endothelium-dependent dilation increased significantly (P<0.05)and MDA、ET-1decreased significantly (P<0.05)in both groups,which were more obvious in obesity group than those in non-obesity group(P<0.05). There were no significant difference in glyceryltrinitrate-mediated endothelium-independent dilation between post-treatment and pre-treatment in both groups (P>0.05)Conclusions:1.There is severe OS damage in T2DM patients with ED and abdominal obesity.That is:OS increases and the ability of anti-OS decreases. MDA is higher and SOD、GSH-Px are lower in AO group than those in NAO group.2. There is severe pancreatic beta-cell dysfunction in T2DM patients with ED and abdominal obesity. AUC、ISI are lower in AO group than those in NAO group.3. There is severe damage of endothelium function in T2DM patients with ED and abdominal obesity.ET-1is higher and NO is lower in AO group than those in NAO group. 4.ED is more severe in AO group,whose score of IIEF-5is lower than that in NAO group.5.The pancreatic beta-cell dysfunction、damage of endothelium function and ED relate consanguineously to OS in T2DM patients with ED and abdominal obesity.That is:With OS is impressed, The pancreatic beta-cell dysfunction、damage of endothelium function and ED are improved correspondingly.6. Antioxidant LA can impress OS effectively in T2DM patients with ED and abdominal obesity and then improve the pancreatic beta-cell function endothelium function and erectile function of those patients and is of good safety.