Combination of Gabapentin and Vitamin B12 Compared with Gabapentin Monotherapy on Pain Improvement of Diabetic Neuropathy Patients

Mochamad Firdaus Bhuanaputra, Alya Tursina, Yuktiana Kharisma

Abstract


Diabetic neuropathy is the most common microvascular complication of diabetes mellitus (DM) occurring in 60–70% of the world's DM population, 40% of the DM population in Asia, and 41% of the DM population in Indonesia. The primary treatment of diabetic neuropathy pain in Indonesia is gabapentin and vitamin B12. The study aimed to compare pain improvements in diabetic neuropathy patients. The drug used was a combination of gabapentin and vitamin B12 and gabapentin monotherapy. For the pain degree measurement, we used the visual analogue scale (VAS). This experimental study was a pretest-posttest randomized control trial using a single-blind method at Dr. M. Salamun Air Force Hospital Bandung from March to May 2017. Samples were 44, type two diabetic neuropathy patients. The Mann-Whitney test to compare pain improvement between 2 groups applied. The results indicated there were differences in pain improvement between diabetic neuropathy patients with gabapentin and vitamin B12 combination compare to gabapentin monotherapy (p=0.002). This result showed a synergistic effect of gabapentin as an inhibitor of neurotransmitter and vitamin B12 expenditure as an improvement in peripheral nerve cells. This study concluded that gabapentin and vitamin B12 combination is better in improving pain in diabetic neuropathy patients compared to gabapentin monotherapy.

 

KOMBINASI GABAPENTIN DAN VITAMIN B12 DIBANDING DENGAN MONOTERAPI GABAPENTIN TERHADAP PERBAIKAN NYERI PASIEN NEUROPATI DIABETIK

Neuropati diabetik merupakan komplikasi mikrovaskular terbanyak diabetes melitus (DM) yang terjadi pada 60–70% populasi DM di dunia, 40% populasi DM di Asia, dan 41% populasi DM di Indonesia. Pengobatan utama nyeri neuropati diabetik di Indonesia adalah gabapentin dan vitamin B12. Tujuan penelitian ini membandingkan perbaikan rasa nyeri pada pasien neuropati diabetik. Obat yang diberikan adalah kombinasi gabapentin dan vitamin B12 serta monoterapi gabapentin. Pengukuran tingkat nyeri menggunakan visual analogue scale (VAS). Penelitian eksperimental ini adalah pretest-posttest randomized control trial dengan menggunakan metode single-blind yang dilakukan di RSAU Dr. M. Salamun Bandung dari bulan Maret hingga Mei 2017. Sampel berjumlah 44 jenis, dua pasien neuropati diabetik. Sampel berjumlah 44, pasien neuropati diabetik tipe dua. Uji Mann-Whitney dilakukan untuk membandingkan perbaikan nyeri antara 2 kelompok perlakuan. Hasil penelitian menunjukkan terdapat perbedaan perbaikan rasa nyeri pasien neuropati diabetik yang diberi pengobatan kombinasi gabapentin dan vitamin B12 dibanding dengan monoterapi gabapentin (p=0,002). Hasil ini menunjukkan efek sinergis gabapentin sebagai inhibitor neurotransmiter dan vitamin B12 yang berfungsi memperbaiki sel saraf tepi. Simpulan penelitian ini adalah pengobatan kombinasi gabapentin dan vitamin B12 lebih baik dalam memperbaiki rasa nyeri pada pasien neuropati diabetik dibanding dengan gabapentin saja.


Keywords


Diabetes melitus; diabetes mellitus; diabetic neuropathy; gabapentin; neuropati diabetik; pain repair; perbaikan nyeri; vitamin B12

Full Text:

PDF

References


Bansal D, Gudala K, Muthyala H, Esam HP, Nayakallu R, Bhansali A. Prevalence and risk factors of development of peripheral diabetic neuropathy in type 2 diabetes mellitus in a tertiary care setting. J Diabetes Investig. 2014;5(6):714–21.

Ramachandran A, Snehalatha C, Shetty AS, Nanditha A. Trends in prevalence of diabetes in Asian countries. World J Diabetes. 2012;3(6):110–7.

Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract. 2014;103(2):137–49.

Indonesia Agency of Health Research and Development, Ministry of Health of Republic of Indonesia. Basic health research (Riskesdas) 2013 [Internet]. Jakarta: Indonesia Agency of Health Research and Development, Ministry of Health of Republic of Indonesia; 2013 [cited 2017 June 15]. Available from: http://labdata.litbang.kemkes.go.id/ccount/click.php?id=10.

Malik VS, Popkin BM, Bray GA, Després JP, Willett WC, Hu FB. Sugar-sweetened beverages and risk of metabolic syndrome and type 2 diabetes: a meta-analysis. Diabetes Care. 2010;33(11):2477–83.

Jin W, Patti ME. Genetic determinants and molecular pathways in the pathogenesis of type 2 diabetes. Clin Sci (Lond). 2009;116(2):99–111.

VA Center for Integrated Healthcare. Diabetic neuropathies: the nerve damage of diabetes [Internet]. July 2013 [cited 2017 June 16]. Available from: https://www.mirecc.va.gov/cih-visn2/Documents/Provider_Education_Handouts/Diabetic_Neuropathies_Version_3.pdf.

Chawla R. Complications of diabetes. New Delhi: Jaypee Brothers Medical Publishers; 2012.

Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM. Diabetic neuropathic pain: physiopathology and treatment. World J Diabetes. 2015 Apr 15;6(3):432–44.

Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: where are we now and where to go? J Diabetes Investig. 2011;2(1):18–32.

Emerging Risk Factors Collaboration, Sarwar N, Gao P, Seshasai SR, Gobin R, Kaptoge S, Di Angelantonio E, et al. Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: a collaborative meta-analysis of 102 prospective studies. Lancet. 2010;375(9733):2215–22.

Wiffen PJ, Derry S, Moore RA, Aldington D, Cole P, Rice AS, et al. Antiepileptic drugs for neuropathic pain and fibromyalgia - an overview of Cochrane reviews. Cochrane Database Syst Rev. 2013;(11):CD010567.

Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6:CD007938.

Murnion BP. Neuropathic pain: current definition and review of drug treatment. Aust Prescr. 2018 Jun;41(3):60–3.

Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–23.

Rosenquist RW, Vrooman BM. Chronic pain managament. In: Butterworth JF, Mackey DC, Wasnick JD, editors. Morgan and Mikhail's Clinical Anesthesiology. 5th Edition. New York: McGraw-Hill Companies; 2013. p. 1023–86.

Agency for Healthcare Research and Quality, U.S. Department of Health & Human Services. Effectiveness of treatments for diabetic peripheral neuropathy [Internet]. May 13, 2016 [cited 2017 June 17]. Available from: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/diabetic-neuropathy_research-protocol.pdf.

Baraz S, Zarea K, Shahbazian HB, Latifi SM. Comparison of the accuracy of monofilament testing at various points of feet in peripheral diabetic neuropathy screening. J Diabetes Metab Disord. 2014;13(1):19.

Wang F, Zhang J, Yu J, Liu S, Zhang R, Ma X, et al. Diagnostic accuracy of monofilament tests for detecting diabetic peripheral neuropathy: a systematic review and meta-analysis. J Diabetes Res. 2017;2017:8787261.

Dros J, Wewerinke A, Bindels PJ, van Weert HC. Accuracy of monofilament testing to diagnose peripheral neuropathy: a systematic review. Ann Fam Med. 2009 Nov-Dec;7(6):555–8.

Mimenza Alvarado A, Aguilar Navarro S. Clinical trial assessing the efficacy of gabapentin plus B complex (B1/B12) versus pregabalin for treating painful diabetic neuropathy. J Diabetes Res. 2016;2016:4078695.

Jayabalan B, Low LL. Vitamin B supplementation for diabetic peripheral neuropathy. Singapore Med J. 2016;57(2):55–9.

Surcheva S, Todorova L, Maslarov D, Vlaskovska M. Preclinic and clinic effectiveness of gabapentin and pregabalin for treatment of neuropathic pain in rats and diabetic patients. Biotechnol Biotechnol Equip. 2017;31(3):568–73.

Vinik AI, Casellini CM. Guidelines in the management of diabetic nerve pain: clinical utility of pregabalin. Diabetes Metab Syndr Obes. 2013;6:57–78.

Lal R, Sukbuntherng J, Luo W, Tovera J, Lassauzet ML, Cundy KC. Population pharmacokinetics and pharmacodynamics of gabapentin after administration of gabapentin enacarbil. J Clin Pharmacol. 2013;53(1):29–40.




DOI: https://doi.org/10.29313/gmhc.v8i1.3676


pISSN 2301-9123 | eISSN 2460-5441

Visitor since 19 October 2016:

View My Stats

Free counters!

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.