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One concern arose in patients already taking maximum doses of sulfonylureas who were randomized to early (lacking symptoms of hyperglycemia) use

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Moreover, ALA exerts antioxidant effects via a dual mechanism: (i) rapid redox-cycling between its disulfide (ALA) and dihydrolipoate (DHLA) forms, which directly quenches ROS without transcriptional activation, and (ii) secondary upregulation of the Nrf2 pathway and suppression of NF-B nuclear translocation (Ghibu et al., 2009)

8mg weekly dose The 8mg tier produced 22.8% body weight loss at 48 weeks