ABSTRACT
AIMS: Glimepiride, a third generation sulfonylurea (SU), is known to have extrapancreatic effects, but its vascular effect is unclear. We investigated the efficacy of glimepiride in improving arterial stiffness assessed by cardio-ankle vascular index (CAVI) in type 2 diabetic patients, compared with glibenclamide, a conventional SU. METHODS: Forty type 2 diabetic patients were randomly assigned to two groups. One group was administered glimepiride 1.5 mg/day, and the other group was administered glibenclamide 1.25 mg/day for 6 months. RESULTS: No significant difference in hypoglycaemic effect was observed between two groups. CAVI significantly decreased only in glimepiride group (9.4 ± 1.4â8.9 ± 0.8, p < 0.05). Decrease in CAVI was greater in glimepiride group than in glibenclamide group (-0.50 ± 0.98 vs. -0.04 ± 0.57, p = 0.048). Urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) decreased in glimepiride group and increased in glibenclamide group, and the changes were significantly different between groups (-1.5 ± 3.5 vs. + 1.8 ± 3.6, p = 0.009); whereas serum lipoprotein lipase mass increased in glibenclamide group and decreased in glibenclamide group, and the changes tended to be different between groups (+ 2.1 ± 19.1 vs. -7.4 ± 19.2, p = 0.096). Change in urinary 8-OHdG was a significant independent predictor for change in CAVI in all subjects. CONCLUSIONS: These results suggest that glimepiride improves CAVI compared with glibenclamide. Reduced oxidative stress and improved insulin resistance may contribute to the improvement of CAVI by glimerpiride.
Subject(s)
Diabetes Mellitus, Type 2/drug therapy , Diabetic Angiopathies/drug therapy , Glyburide/therapeutic use , Hypoglycemic Agents/therapeutic use , Sulfonylurea Compounds/therapeutic use , Vascular Stiffness/drug effects , 8-Hydroxy-2'-Deoxyguanosine , Aged , Ankle/blood supply , Deoxyguanosine/analogs & derivatives , Deoxyguanosine/metabolism , Diabetes Mellitus, Type 2/physiopathology , Diabetic Angiopathies/physiopathology , Female , Glycated Hemoglobin/metabolism , Humans , Lipids/blood , Male , Middle Aged , Vascular Resistance/drug effectsABSTRACT
AIM: To evaluate outcomes after photodynamic therapy (PDT) with verteporfin in Japanese patients with age-related macular degeneration (AMD) or polypoidal choroidal vasculopathy (PCV) and compare results with the presence/absence of a retinal pigment epithelial detachment (PED). METHODS: We retrospectively reviewed 183 eyes with subfoveal choroidal neovascularisation secondary to AMD with more than 3 months' follow-up (range 3 to 36; mean 15.6). A serous PED developed in 44 of 183 eyes. RESULTS: A total of 124 eyes (67.8%) completed 12 months' follow-up. In 49 eyes with typical AMD, the best-corrected visual acuity (BCVA) improved a mean of 0.48 line. A significant (p<0.05 to p<0.0005) decline in VA occurred in eyes with a serous PED during any 3-month period. In 75 eyes with PCV, the BCVA at 12 months improved a mean of 1.79 lines. There was no significant difference between the BCVA in 22 eyes with a PED and 53 eyes without a PED during any 3 months. CONCLUSIONS: In eyes with typical AMD, a serous PED was associated with a significant decline in BCVA compared with eyes without a serous PED. In eyes with PCV, the visual outcomes were unaffected by a serous PED. When PDT is administered, differentiating PCV from typical AMD using indocyanine green angiography is important.
Subject(s)
Choroidal Neovascularization/drug therapy , Macular Degeneration/drug therapy , Photosensitizing Agents/administration & dosage , Porphyrins/administration & dosage , Retinal Detachment/drug therapy , Aged , Choroidal Neovascularization/etiology , Coloring Agents/therapeutic use , Female , Fluorescein Angiography/methods , Humans , Indocyanine Green/therapeutic use , Macular Degeneration/complications , Male , Photochemotherapy/methods , Retinal Detachment/diagnosis , Retrospective Studies , Tomography, Optical Coherence , Treatment Outcome , Verteporfin , Visual AcuityABSTRACT
OBJECTIVE: To evaluate the effect and safety of treatment with low-calorie formula diet on renal function and proteinuria in obese patients with diabetic nephropathy. DESIGN: Prospective study on safety and efficacy of a 4-week low-calorie (11-19 kcal/kg/day) normal-protein (0.9-1.2 g/kg/day) diet partly supplemented with formula diet. SUBJECTS: In all, 22 obese patients with diabetic nephropathy (BMI: 30.4+/-5.3 kg/m(2), HbA1c: 7.1+/-1.4%, serum creatinine: 172.4+/-57.5 micromol/l, urinary protein: 3.3+/-2.6 g/day). RESULTS: The mean body weight decreased by 6.2+/-3.0 kg. The mean systolic blood pressure, creatinine, blood urea nitrogen, urinary protein, and 8-hydroxydeoxyguanosine decreased significantly by 7.5+/-12.7 mmHg, 41.6+/-23.9 micromol/l, 1.50+/-1.61 mmol/l, 1.8+/-1.7 g/day, and 3.1+/-3.6 ng/mg creatinine, respectively. No patient had increased serum creatinine and urinary protein. Mean creatinine clearance (40.6+/-17.9 to 46.1+/-14.6 ml/s/1.73 m(2)) and serum albumin showed no significant changes. Delta serum creatinine and Delta urinary protein correlated with Delta body weight (r=0.62 and 0.49, respectively) and Delta visceral fat area (r=0.58 and 0.58, respectively), but did not correlate with Delta systolic blood pressure, Delta fasting blood glucose and Delta subcutaneous fat area. CONCLUSION: These results suggested that weight reduction using formula diet might improve renal function and proteinuria safely for a short term in obese patients with diabetic nephropathy.
