Microvascular complications are responsible for a major proportion of the burden associated
with diabetes contributing to substantial morbidity, mortality, and healthcare costs
in people with diabetes. Retinopathy, nephropathy, and neuropathy constitute the leading
causes of blindness, end-stage renal disease, and lower-extremity amputations, respectively.
Since the efficacy of causal therapies of diabetic microvascular complications is
limited, especially in type 2 diabetes, there is an unmet need for adjunct treatments
which should be effective despite ongoing hyperglycemia. Experimental studies indicate
that diabetic microvascular complications can be prevented or ameliorated by various
biofactors in animal models by interfering with the pathophysiology of the underlying
condition. Some of the findings related to biofactors like α-lipoic acid and benfotiamine
could be translated into the clinical arena and confirmed in clinical trials, especially
in those focusing on diabetic polyneuropathy. Given the micronutrient nature of these
compounds, their safety profile is excellent. Thus, they have the potential to favorably
modify the natural history of the underlying complication, but large long-term clinical
trials are required to confirm this notion. Ultimately, biofactors should expand our
therapeutic armamentarium against these common, debilitating, and even life-threatening
sequelae of diabetes.
