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PMCID: PMC5876407.

In more severe cases, joint deformity, fever, and intense pain can occur, leading to long-term disability

This contrasts with synthetic drugs that may accumulate or produce active metabolites

[8] Patients with diabetes mellitus should use ALA with caution because ALA can enhance glucose utilization and insulin sensitivity, potentially leading to hypoglycemia (low blood sugar) if used alongside insulin or oral antidiabetic drugs

Rapid progression also prevents accurate assessment of what concentration actually delivers results