ABSTRACT
The beneficial effect angiotensin converting enzyme inhibitors (ACEI) and angiotensin II receptor antagonists (ARA) for diabetic nephropathy can be hampered by the phenomenon of aldosterone escape. Aldosterone antagonists such as espironolactone or epleronone could potentiate the effects of ACEI and ARA and avoid the later problem. We performed a systematic search of the literature on the effects of aldosterone antagonists on diabetic nephropathy. We searched for clinical trials and follow up studies measuring the effects of aldosterone antagonists on urinary albumin excretion among patients with diabetic nephropathy. We retrieved 1345 papers on the subject and 10 were selected for analysis. Among these, spironolactone was more effective than comparing drugs to achieve a reduction in urinary albumin excretion of approximately 30 to 40 percent. On the other hand epleronone was not superior to comparing drugs. All studies reported a modest reduction in glomerular filtration rate and an increase in serum potassium levels. In conclusion, spironolactone in doses of 25 to 100 mg/day reduces urinary albumin excretion but reduces also glomerular filtration rate and increases serum potassium levels.
Subject(s)
Humans , Mineralocorticoid Receptor Antagonists/therapeutic use , Spironolactone/therapeutic use , Diabetic Nephropathies/drug therapy , Albuminuria/drug therapy , Mineralocorticoid Receptor Antagonists/adverse effects , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Creatinine , Diabetes Mellitus , Spironolactone/analogs & derivatives , Spironolactone/adverse effects , Glomerular Filtration Rate , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , PotassiumABSTRACT
Backgroud: Latent Autoimmune Diabetes in Adults (LADA) is the term used to describe adults who have a slowly progressive form of diabetes mellitus (DM) of autoimmune etiology, but that may be treated initially without insulin. Although it shares some immunological and genetic aspects with type 1 DM, it affects an age group that is typically affected by type 2 DM. Therefore, it could be considered an intermediate type. Diagnosis is based on clinical and laboratory criteria: age of onset, initial response to oral hypoglycemic agents and the presence of specific antibodies for diabetes. Although the definitive treatment is insulin, glitazones may be useful in early stages of the disease. Currently, its management represents a challenge for the physician, including specialists, and it is a form of DM to keep in mind.
Subject(s)
Adult , Humans , Diabetes Mellitus/immunology , Age Factors , Algorithms , Diabetes Complications/diagnosis , Diabetes Mellitus, Type 1/genetics , Diabetes Mellitus, Type 1/immunology , /immunology , Diabetes Mellitus/genetics , Diabetes Mellitus/therapy , Diagnosis, Differential , Disease Progression , Insulin/therapeutic useABSTRACT
Atypical antipsychotic drugs have less extra pyramidal side effects and are more effective to control the clinical manifestations of schizophrenia. However, their use may be associated to a higher incidence of weight gain, dyslipidemia, metabolic syndrome, glucose intolerance and type 2 diabetes mellitus. We performed a systematic literature search to evaluate the risk of type 2 diabetes mellitus incidence associated to the use of atypical antipsychotic drugs, compared to conventional treatment. If users of all types of atypical antipsychotic drugs are compared with users of conventional treatment, no significant differences in the incidence of type 2 diabetes mellitus were observed. If individual drugs are evaluated, clozapine and risperidone are associated with a higher risk of diabetes than haloperidol. Quetiapine is associated with a lower risk of diabetes than conventional treatment. The quality of the evidence found was low; therefore, new studies should been performed.