α-Lipoic acid, diabetic neuropathy, and Nathan's prophecy

Both oral and intravenous administration of alpha-lipoic acid (ALA) has been investigated as add-on treatment for diabetic peripheral neuropathy. The recent Neurological Assessment of Thioctic Acid in Diabetic Neuropathy (NATHAN) 1 trial has shown that 4-year oral ALA administration is of some value in achieving a clinically meaningful improvement and a slight delay in the progression of neuropathic deficits among patients with mild/moderate diabetic peripheral neuropathy. Despite these promising results, important questions remain to be answered, mainly appropriate patient selection and optimal treatment duration. Moreover, a cost-benefit analysis would be useful.