Clinical And Economical Observation Of Alpha-lipoic Acid、Mecobalamin And Beraprost Sodium Oreal Treatment Of Diabetic Peripheral Neuropathy

Diabetic peripheral neuropathy (DPN) refers the case to rule out other causes of diabetes in patients with peripheral nerve dysfunction symptoms and (or) signs. It is one of the most common chronic complication of diabetes, and also the leading causes of disability of patients with diabetes, its incidence rateis about60%-90%, and may30%-40%have no sydroms. Because of its dormant for DPN onset,Patients are most vulnerable to the loss of protective sensation which due to peripheral neuropathy, then cause foot ulcers and infections, and even lead to a non-traumatic lower extremity low amputation. This is not only harmful to the health of patients, quality of life and a happy family life, but also a heavy financial burden to individuals and society. Its pathogenesis has not been fully elucidated, It is influenced by many factors, including concealment of onset and progress, the lack of specificity of clinical manifestations. At present, people generally believe that it caused by oxidative stress, vascular ischemia and hypoxia, and the lack of nerve growth factors, which are respectively caused by blood suply, metabolic and neurological nutrional disorders. Plus on autoimmune factors, vitamin deficiencies, genetic and environmental factors. This caused great difficulties to the diagnosis and treatment of diabetic peripheral neuropathy. Diabetic peripheral neuropathy is still a lack of specific effective cure. Now the general clinical medications of DPN are the lipoic acid tablets, the mecobalamin tablets and the beraprost sodium tablets. However, most of the clinical data focus on the intravenous medication, and the treatments have a lot medical costs, take Social proportion of health care resources, the clinical observation of the oral medication is rarely reported. Diabetic peripheral neuropathy is a chronic disease that requires long-term drug treatment. Using simple, effective and low-cost treatment as soon as possible, not only can improve the patient’s health status, to mitigate the lack of medical resources, but also can greatly reduce the social and personal economic burden. In this study,through the clinical observation and health economics analysis of these three oral medication alone and combination treatment of diabetic peripheral neuropathy, we can provide a reference for both doctors and patients in how to choose a priority disease intervention.Objiective:1.Observe the efficacy of the outpatients who take mecobalamin, alpha-lipoic acid and beraprost sodium to treat diabetic peripheral neuropathy, and do a cost-effectiveness analysis of different treatment, to explore the preferred treatment options which has both clinically effective and low consumption of medical expenses.Methods:178outpatients with type2diabetes mellitus complicated by diabetic peripheral neuropathy,the ones who use oral medications to treat DPN, hospitalized in the ChangHai Hospital from November,2011to September,2012. There are92male patients and78female patients. They are42to75years old, their average age is. Depending on the different drug treatment of diabetic peripheral neuropathy, there are39patients in Mecobalamin group (M group),34patients in Alpha lipoic acid group (A group),25patients in Beraprost Sodium group (B group),29patients in lipoic acid and Mecobalamin group (AM group),26patients in Beraprost and Mecobalamin group (BM group) and25patients in lipoic acid and Beraprost group (AB group). The diagnosis of Diabetes mellitus accroded with the new diagnosis criteria of WHO in1999. All the patients have a good base that fasting blood-glucose (FBG)<7.0mmol/L,2h blood-glucose<10.0mmol/L, HbA1c <7.0%. Regular using oral medication to treat DPN in30days, we can analysis on their efficacy and economical cost of Diabetic peripheral neuropathy.Results:Three oral agents used alone (A、B、M group) have a certain effectiveness, but have no significant difference, p>0.05. relative to the the three oral medication used alone, the validity of AM、BM、AB group have significant difference, p<0.05. Between the different combinations,there are also no significant difference, p>0.05. Compaired with before and after the treatment, using different single drugs all the nerve conduction velocity have a big improvement, p<0.05. And between the three drugs, there also have a significant difference in Median nerve’s Sensory nerve conduction velocity and Peroneal nerve’s Motor nerve conduction velocity. During the Cost-effectiveness analysis, in the single drugs, Mecobalamin proved to be the cost-effective option. And in the combination groups, alpha lipoic acid proved to be the most preferred embodiment.Conclusions:Using lipoic acid tablets, methylcobalamin tablets or the beraprost sodium tablets treatment in patients with diabetic peripheral neuropathy, nerve conduction velocity were improved. And using Mecobalamin tablets has a significant improvement on the median nerve sensory conduction velocity and peroneal nerve motor conduction velocity. Using lipoic acid, mecobalamin, beraprost sodium oral formulations could be available treatments for the patients with diabetic peripheral neuropathy. The combination therapy groups are better. During the Cost-effectiveness analysis, in the single drugs, Mecobalamin proved to be the cost-effective option. And in the combination groups, alpha lipoic acid proved to be the most preferred embodiment.