Aims/hypothesis High-dose supplements of thiamine prevent
the development of microalbuminuria in experimental
diabetes. The aim of this pilot study was to assess whether
oral supplements of thiamine could reverse microalbuminuria
in patients with type 2 diabetes.
Methods Type 2 diabetic patients (21 male, 19 female) with
microalbuminuria were recruited at the Diabetes Clinic, Sheikh
Zayed Hospital, Lahore, Pakistan, and randomised to placebo
and treatment arms. Randomisation was by central office in
sequentially numbered opaque, sealed envelopes. Participants,
caregivers and those assessing the outcomes were blinded to
group assignment. Patients were given 3×100 mg capsules of
thiamine or placebo per day for 3 months with a 2 month
follow-up washout period. The primary endpoint was change
in urinary albumin excretion (UAE). Other markers of renal
and vascular dysfunction and plasma concentrations of
thiamine were determined.
Results UAE was decreased in patients receiving thiamine
therapy for 3 months with respect to baseline (median
−17.7 mg/24 h; p<0.001, n=20). There was no significant
decrease in UAE in patients receiving placebo after 3 months
of therapy (n=20). UAE was significantly lower in patients
who had received thiamine therapy compared with those who
had received placebo (30.1 vs 35.5 mg/24 h, p<0.01) but not
at baseline. UAE continued to decrease in the 2 month
washout period in both groups, but not significantly. There
was no effect of thiamine treatment on glycaemic control,
dyslipidaemia or BP. There were no adverse effects of therapy.
Conclusions/interpretation In this pilot study, high-dose
thiamine therapy produced a regression of UAE in type 2
diabetic patients with microalbuminuria. Thiamine supplements
at high dose may provide improved therapy for
early-stage diabetic nephropathy
-http://www.springerlink.com/content/51l034044218455j/fulltext.pdf
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Vitamin B Therapy Adversely Affects Progression of Diabetic Nephropathy
ReplyDeleteB vitamins given to lower homocysteinemia — and thereby to reduce renal and vascular complications of diabetes — don't have the desired effect, according to a JAMA study.
Researchers randomized nearly 250 patients with diabetic nephropathy to either high-dose B vitamins or placebo. The study's primary outcome measure was the change in glomerular filtration rate (GFR) between baseline and study's end.
After a mean follow-up of 32 months, GFRs declined more, on average, in the treatment group than in the control group (16.5 vs. 10.7 mL/min). A composite outcome of myocardial infarction, stroke, revascularization, and all-cause mortality also favored controls. The need for dialysis did not differ between groups. Homocysteine values, however, were significantly lower in the treatment group.
Pointing to earlier studies showing no treatment benefit, the authors conclude that "it would be prudent to discourage the use of high-dose B vitamins as a homocysteine-lowering strategy."