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The exact incidence remains lowtypically less than 2% of usersbut individual cases do surface

Chronic inflammation is sustained by a lack of Notch signaling leading to toll-like receptor stimulation with subsequent TNF- and IL-1 secretion causing dendritic cell activation and IL-23 release which polarizes Th17 cells and leads to increased IL-17

In placebo controlled clinical trials in patients with diabetes and peripheral neuropathy, alpha lipoic acid was associated with mild improvements in surrogate markers of neuropathy but was not shown to ameliorate symptoms or progression of neuropathy

The primary safety concern is increased hypoglycaemia risk