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Treatment of diabetic polyneuropathy with the antioxidant thioctic acid (alpha-lipoic acid): a two year multicenter randomized double-blind placebo-controlled trial (ALADIN II)

NRF2 activation plays a key role in cellular repair during sleep by upregulating antioxidant enzymes (SOD, catalase, HO-1), reducing oxidative damage, and promoting mitochondrial biogenesis, which are critical for neuronal recovery and energy homeostasis

This leads to a reduction in circulating LPS levels, thereby ameliorating LPS-induced systemic and hepatic inflammation, which in turn improves insulin signaling such as via the PI3K/AKT pathway and reduces insulin resistance, ultimately promoting better glucose uptake and lipid homeostasis [115]

Finally, this twice-daily dose of Lcarnitine supports recovery after exercise

Metabolites, as the ultimate product of gene expression, are crucial links between genotype and phenotype