ABSTRACT
BACKGROUND: The aim of his study was to compare the efficacy of pioglitazone with metformin on the reduction of albuminuria in type 2 diabetic patients with hypertension and microalbuminuria treated with renin-angiotensin system inhibitors (RAS-Is). METHODS: The open-label, randomized trial was performed in type 2 diabetic patients with hypertension and microalbuminuria. On the basis of the treatment with RAS-Is, 68 patients with microalbuminuria received either pioglitazone (15-30 mg/day; n = 32) or metformin (500-750 mg/day; n = 31) for 52 weeks. Urinary albumin-to-creatinine ratio (UACR) was measured every 12 weeks. RESULTS: After 52 weeks of treatment, the changes in the log-UACR from baseline were -8.3% in the pioglitazone group and +4.2% in the metformin group (p = 0.01), with similar glycemic and blood pressure changes. CONCLUSION: The combination of pioglitazone and RAS-Is showed therapeutic benefit in the reduction of urinary albumin excretion for type 2 diabetic patients with hypertension and microalbuminuria.
Subject(s)
Albuminuria/drug therapy , Angiotensin II Type 1 Receptor Blockers/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Antihypertensive Agents/therapeutic use , Diabetes Mellitus, Type 2/drug therapy , Diabetic Nephropathies/drug therapy , Hypertension/drug therapy , Hypoglycemic Agents/therapeutic use , Renin-Angiotensin System/drug effects , Thiazolidinediones/therapeutic use , Albuminuria/etiology , Albuminuria/urine , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/urine , Diabetic Nephropathies/etiology , Diabetic Nephropathies/urine , Female , Humans , Hypertension/etiology , Hypertension/urine , Japan , Male , Metformin/therapeutic use , Middle Aged , Pioglitazone , Time Factors , Treatment OutcomeABSTRACT
This study was designed to compare the effect of candesartan on cardiac left ventricular mass in Japanese patients with that of amlodipine. A total of 40 type 2 diabetic patients with hypertension and left ventricular hypertrophy (LVH) were randomly assigned to receive candesartan (n=20) or amlodipine (n=20). The two treatments when administered for 6 months significantly reduced systolic and diastolic blood pressures (BPs) to a comparable extent. Notably, candesartan significantly reduced left ventricular mass index (LVMI: from 131.5+/-4.5 to 112.1+/-5.9g/m(2), P=0.0009, M+/-S.E.M.), LV posterior wall thickness (PWTd: from 10.3+/-0.3 to 9.1+/-0.3mm, P=0.0052) and interventricular septal thickness (IVSTd: from 10.7+/-0.4 to 9.3+/-0.4mm, P=0.0019) as determined by echocardiography in diastole, but amlodipine treatment did not. LVMI, PWTd and IVSTd were decreased more significantly by the treatment with candesartan than by that with amlodipine (P=0.020, 0.031 and 0.043). The present study thus revealed that candesartan effectively induced regression of LVH in type 2 diabetic patients with hypertension due to effects beyond reduction in BP.
Subject(s)
Amlodipine/therapeutic use , Antihypertensive Agents/therapeutic use , Benzimidazoles/therapeutic use , Cardiomegaly/drug therapy , Diabetes Mellitus, Type 2/complications , Diabetic Angiopathies/drug therapy , Hypertension/drug therapy , Tetrazoles/therapeutic use , Adult , Aged , Biphenyl Compounds , Blood Pressure , Female , Heart Rate , Humans , Male , Middle Aged , Patient Selection , Ventricular Dysfunction, Left/drug therapyABSTRACT
A case of type 2 diabetic patient, a 67-year-old woman, with a large abscess of the gastric wall which seemed to be a primary lesion is described for the first time. Fortunately, patient was successfully treated with both the maintenance of a good glycemic control and systemic antibiotics without laparotomy or drainage. Thus, a tight glycemic control and awareness of this disease should be reemphasized, and this may improve the prognosis of this rare and fatal one, even a poorly-controlled diabetes.
Subject(s)
Abdominal Abscess/complications , Abdominal Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/drug therapy , Abdominal Abscess/diagnostic imaging , Aged , Blood Glucose/metabolism , Female , Humans , Hypoglycemic Agents/therapeutic use , Insulin/therapeutic use , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Diabetes Mellitus, Experimental , Disease Models, Animal , Alloxan , Animals , Rats , StreptozocinABSTRACT
Effects of the prostanoids on the growth of cultured aortic vascular smooth muscle cells (VSMCs) were examined using mice lacking prostanoid receptors. Proliferation of VSMCs was assessed by measuring [(3)H]-thymidine incorporation and the cell number, and their hypertrophy by [(14)C]-leucine incorporation and protein content. In VSMCs from wild-type mice, expressions of mRNAs for the EP(4) and TP were most abundant, followed by those for the IP, EP(3) and FP, when examined by competitive reverse transcriptase-PCR. Those for the EP(1), EP(2) and DP, however, could not be detected. AE1-329, an EP(4) agonist, and cicaprost, an IP agonist, inhibited platelet derived growth factor (PDGF)-induced proliferation of VSMCs from wild-type mice; these inhibitory effects disappeared completely in VSMCs from EP(4)(-/-) and IP(-/-) mice, respectively. In accordance with these effects, AE1-329 and cicaprost stimulated cAMP production in VSMCs from wild-type mice, which were absent in VSMCs from EP(4)(-/-) and IP(-/-) mice, respectively. Effects of PGE(2) on cell proliferation and adenylate cyclase were almost similar with those of AE1-329 in VSMCs from wild-type mice, which disappeared in VSMCs from EP(4)(-/-) mice. PGD(2) inhibited PDGF-induced proliferation of VSMCs from both wild-type and DP(-/-) mice to a similar extent. This action of PGD(2) was also observed in VSMCs from EP4(-/-) and IP(-/-) mice. In VSMCs from wild-type mice, I-BOP, a TP agonist, showed potentiation of PDGF-induced hypertrophy. I-BOP failed to show this action in VSMCs from TP(-/-) mice. The specific agonists for the EP(1), EP(2) or EP(3), and PGF(2)alpha showed little effect on the growth of VSMCs. These results show that PGE(2), PGI(2) and TXA(2) modulate PDGF-induced proliferation or hypertrophy of VSMCs via the EP(4), IP and TP, respectively, and that the inhibitory effect of PGD(2) on PDGF-induced proliferation is not mediated by the DP, EP(4) or IP.