{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,3]],"date-time":"2026-10-03T19:22:41Z","timestamp":1791055361152,"version":"4.1.0"},"reference-count":98,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,10,23]],"date-time":"2020-10-23T00:00:00Z","timestamp":1603411200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Aim: To investigate the efficacy of Superoxide Dismutase, Alpha Lipoic Acid, Acetyl L-Carnitine, and Vitamin B12 (B12) in one tablet in Diabetic Neuropathy (DN). Patients\u2013methods: In this prospective, double-blind, placebo-controlled study, 85 patients with Diabetes Mellitus Type 2 (DMT2) were randomly assigned, either to receive the combination of four elements (active group, n = 43), or placebo (n = 42) for 12 months. We used the Michigan Neuropathy Screening Instrument Questionnaire and Examination (MNSIQ and MNSIE), measured the vibration perception threshold (BIO), and Cardiovascular Autonomic Reflex Tests (CARTs). Nerve function was assessed by DPN Check [sural nerve conduction velocity (SNCV) and amplitude (SNAP)]. Pain (PS) and quality of life (QL) questionnaires were administered. Results: At follow-up, BIO, MNSIQ, QL, PAIN, and SNCV, SNAP, and B12 levels had significantly improved inactive group (p &lt; 0.001, p &lt; 0.001, p &lt; 0.001, p &lt; 0.001, p = 0.027, p = 0.031, and p &lt; 0.001 respectively), whereas the inplacebo group MCR (mean circular resultant) and PAIN deteriorated (p &lt; 0.001, p &lt; 0.001). The changes in MNSIQ, QL, SNCV, BIO, and PAIN differed significantly between groups (p &lt; 0.001, p &lt; 0.001, p = 0.031, p &lt; 0.001, and p &lt; 0.001 respectively). Conclusions: The combination of the four elements in one tablet for 12 months in patients with DMT2 improved all indices of peripheral neuropathy, including SNAP and SNCV, pain, and Quality of Life perception, except CARTs and MNSIE.<\/jats:p>","DOI":"10.3390\/nu12113254","type":"journal-article","created":{"date-parts":[[2020,10,26]],"date-time":"2020-10-26T02:34:54Z","timestamp":1603679694000},"page":"3254","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":61,"title":["Efficacy and Safety of the Combination of Superoxide Dismutase, Alpha Lipoic Acid, Vitamin B12, and Carnitine for 12 Months in Patients with Diabetic Neuropathy"],"prefix":"10.3390","volume":"12","author":[{"given":"Triantafyllos","family":"Didangelos","sequence":"first","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7094-0338","authenticated-orcid":false,"given":"Eleni","family":"Karlafti","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4841-1928","authenticated-orcid":false,"given":"Evangelia","family":"Kotzakioulafi","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zisis","family":"Kontoninas","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalampos","family":"Margaritidis","sequence":"additional","affiliation":[{"name":"Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, University General Hospital of Thessaloniki AHEPA, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9413-6368","authenticated-orcid":false,"given":"Parthena","family":"Giannoulaki","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, University General Hospital of Thessaloniki AHEPA, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0584-1138","authenticated-orcid":false,"given":"Konstantinos","family":"Kantartzis","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine IV, Division of Endocrinology, Diabetology and Nephrology, University of T\u00fcbingen, 72076 T\u00fcbingen, Germany"},{"name":"Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Centre Munich at the University of T\u00fcbingen, 72076 T\u00fcbingen, Germany"},{"name":"German Center for Diabetes Research (DZD), 72076 T\u00fcbingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"956","DOI":"10.2337\/diacare.28.4.956","article-title":"Diabetic Neuropathies: A statement by the American Diabetes Association","volume":"28","author":"Boulton","year":"2005","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2285","DOI":"10.2337\/dc10-1303","article-title":"Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments","volume":"33","author":"Tesfaye","year":"2010","journal-title":"Diabetes Care"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1226","DOI":"10.1212\/01.CON.0000455884.29545.d2","article-title":"Diabetic Neuropathies","volume":"20","author":"Russell","year":"2014","journal-title":"Contin. 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