Effects on urinary albumin excretion and renal function changes by delapril and manidipine in normotensive type 2 diabetic patients with microalbuminuria.

This study was designed to investigate the effect of delapril, an ACE inhibitor, and manidipine, a long action calcium antagonist, on persistent microalbuminuria in normotensive type 2 diabetic patients. Sixty type 2 diabetic patients were randomized to take delapril 30 mg/day or manidipine 10 mg/day for 48 weeks, in an open label design. Twenty eight of thirty subjects in the delapril group and twenty nine of thirty in the manidipine group completed the study. Urine albumin excretion as measured by the urinary albumin creatinine ratio decreased significantly in both groups (112.0+/-60.9 to 95.3+/-64.9 mg/g and 108.5+/-51.0 to 96.4+/-53.5 mg/g in the delapril and manidipine group respectively, p < 0.05, by paired t-test). Systolic and diastolic blood pressure were not significantly changed after treatment in the delapril group but significantly decreased in the manidipine group (130.9+/-7.1/80.2+/-6.1 to 127.2+/-7.1/78.0+/-5.3 mm/Hg, p < 0.05, by student's paired t-test). After 48 weeks of treatment, two patients in the delapril group and one patient in the manidipine group converted to normoalbuminuria (urinary albumin:creatinine ratio < 30 mg/g) and one patient in each group progressed to overt nephropathy (urinary albumin:creatinine ratio > 300 mg/g). There were no significant changes in fasting plasma glucose, HbA1c, serum fructosamine, creatinine, potassium and lipid profiles after 48 weeks of treatment in both groups. Two cases in the delapril group were withdrawn during the study because of an intolerable cough and one case in the manidipine group because of intolerable dizziness and headache. In conclusion, both delapril and manidipine are effective in the reduction of microalbuminuria in normotensive type 2 diabetic patients with persistent microalbuminuria.

Efficacy of acarbose as monotherapy in NIDDM patients.

The efficacy and safety of acarbose (100 mg three times a day for 12 weeks) was investigated in an open study in patients with non-insulin dependent diabetes mellitus who could not achieve satisfactory glycaemic control by diet alone. Acarbose significantly decreased fasting plasma glucose from 165.9 +/- 16.0 mg/dl to 159.5 +/- 16.9 mg/dl (P value < 0.01). The reduction of postprandial plasma glucose was 11.2 per cent and 9.8 per cent for 1 hour and 2 hours respectively. HbAic also significantly decreased from the baseline. The most common side effects were mild to moderate flatulence and abdominal distension. There were no significant changes in body weight, lipid profile and other biochemical parameters. These results indicate that treatment with acarbose is safe and effective in adjunct to dietary therapy for the treatment of NIDDM.

Clinical evaluation of pravastatin in the treatment of type II hyperlipidemia in patients with non-insulin-dependent diabetes mellitus.

The study was conducted on 30 NIDDM patients with type II hyperlipoproteinemia. They consisted of 13 males and 17 females with the mean (+/- S.D.) age of 60.6 +/- 7.6 year. They were treated with a daily dose of 10 mg pravastatin given orally twice a day for 16 weeks. Their mean (+/- S.D.) serum TC, LDL-C, TG and HDL-C levels at week 0 were 259.7 +/- 22.6, 177.4 +/- 20.3, 173.9 +/- 62.3 and 44.0 +/- 9.9 mg/dl respectively. After receiving pravastatin the maximal reduction of TC, LDL-C and TG was 22.9, 31.2 and 17.1 per cent with statistical significant difference from the baseline. The maximal increment of HDL-C was 11.9 per cent, also showing statistical significant difference from the baseline. Plasma glucose, serum fructosamine and glycated hemoglobin were not affected by pravastatin. There were no significant changes in the patients' body weight and other biochemical parameters except for one case who had transient slight increase in transaminase during pravastatin treatment. These results indicate that pravastatin is an effective and safe drug in diabetic patients with hypercholesterolemia.

Gestational diabetes mellitus.

The prevalence of gestational diabetes mellitus by screening 25,997 pregnant women in Rajavithi Hospital during a two-year-period was 2.02 per cent. Of the 312 gestational diabetes patients available for the study, their mean age was 29 years. Risk factors included a BMI before pregnancy of more than 26 (26.5%), family history of diabetes mellitus (23.1%), history of abortion (14.4%), and history of fetal death in utero (3.2%). Macrosomia, congenital anomalies and cesarean delivery were found significantly more common in gestational diabetic patients compared to normal pregnancy.

Lipid disorders in Thai diabetic patients at Rajavithi Hospital.

Lipid abnormalities are common in diabetic patients. In this study, 71 per cent had hyperlipidemia. The incidence of combined hyperlipidemia, hypertriglyceridemia, and hypercholesterolemia were 29.5, 25.8 and 15.5 per cent respectively. Females were found to have higher cholesterol levels than males. Cholesterol and triglycerides levels were correlated with BMI and GHb but showed no correlation with age and duration of diabetes. HDL-C showed no correlation with BMI, GHb, age or duration of diabetes.