Effect of Trimetazidine on Endothelin-1 and Clinical Outcomes of Patients With Diabetic Peripheral Neuropathy

• Males or females aged 18-65 years diagnosed with Type 2 Diabetes.
• Regular attendance of the outpatient diabetes clinic of national institute of diabetes to ensure adequate follow up, glycemic control and monitor any complication or side effect.
• Patients diagnosed with Diabetic Neuropathy (by pinprick, temperature, ankle reflex, and vibration perception (128-Hz tuning fork) or pressure sensation (10 g monofilament test).
• Glycated Hgb more than 7%

Exclusion criteria:

• Patients with autoimmune disorders (Sjogren's syndrome, lupus, rheumatoid arthritis), inherited disorders causing peripheral neuropathy, thyroid diseases, chronic inflammatory demyelinating polyneuropathy, patients undergoing gastroplasty surgery, and cancer patients.
• Patients have Parkinson disease or any motor movement disorders
• Any clinically significant cardiac, pulmonary, gastrointestinal, hematologic, or other endocrine disease.
• Pressure on or injury to the nerves
• Patients with kidney (eGFR less than 30 ml/min) or severe liver dysfunction (ALT more than 3x ULN).
• Patients with recent history of infection.
• Patients with cerebral vascular disease, vasculitis, toxic neuritis, spondyloarthropathy, foot edema or ulcer and diagnosis of other neuromuscular disorders or neurodegenerative diseases.
• Use of medications or supplements known to cause peripheral neuropathy.
• Patients consuming alcohol, any antioxidant supplements or anti-inflammatory medicines and drug abuse.
• Ketoacidosis or hypoglycemia resulting in hospital admission within the last 3 months.
• Pregnancy or lactation.
• Medical, psychological, behavioral or pharmacological factors interfering with the ability to participate in a trial.
• Any known allergy to Trimetazidine