Effect of Addition of Losartan to Metformin Alone and in Combination With Glimepiride or Repaglinide in Type 2 Diabetes Patients With Proteinuria

Abstract

Diabetes mellitus is associated with increased oxidative stress due to hyperglycemia. This increased oxidative stress gives rise to micro and macro vascular complications. MATERIALS & METHODS: Randomized comparative prospective trial. Three groups were formed comprising of metformin + losartan, Metformin + Glimepiride + Losartan and metformin + Repaglinide + Losartan. The parameters like glycemic control, lipid profile, antioxidant status and progression of diabetic nephropthy before and after therapy was assessed by fasting blood sugar, glycated Hb, lipid profile, antioxidant status, renal function tests and proteinuria. From the group I & II comparisons our finding is that adding glimepiride or repaglinide to the basic regime of M + losartan has increased advantage and favorable effect. From comparison of group II & III finding is that repaglinide addition to the basic regime of M+ losartan had more favorable and increased advantage over glimepiride addition. The test for significant proteinuria and renal function tests was performed before enrollment and after completion of the study. After completion of the study no any patient was having significant proteinuria and all the patients have normal renal function tests. CONCLUSION: Losartan efficiently reduces proteinuria with adequate tolerance in presence of adequate glycaemic control. M + repaglinide + losartan combination is highly effective in controlling proteinuria. Several mechanisms may explain these effects. Although no glomerular hemodynamic parameters were analyzed in the present study, we consider that the attenuation of proteinuria reflects an improvement in the glomerular function. Losartan has been shown to reduce proteinuria by improving glomerular basement membrane characteristics. Losartan by targeting renin angiotensin aldosterone system improves overall glomerular function. This study is of interest since hypertension, which increases intra glomerular pressure and cause further progression of nephropathy, was similarly reduced with losartan administration.