S. Nielsen et al., RENAL-FUNCTION AND INSULIN SENSITIVITY DURING SIMVASTATIN TREATMENT IN TYPE-2 (NON-INSULIN-DEPENDENT) DIABETIC-PATIENTS WITH MICROALBUMINURIA, Diabetologia, 36(10), 1993, pp. 1079-1086
Citations number
64
Categorie Soggetti
Endocrynology & Metabolism","Medicine, General & Internal
The effect of simvastatin (10-20 mg/day) on kidney function, urinary a
lbumin excretion rate and insulin sensitivity was evaluated in 18 Type
2 (non-insulin-dependent) diabetic patients with microalbuminuria and
moderate hypercholesterolaemia (total cholesterol greater-than-or-equ
al-to 5.5 mmol.l-1). In a double-blind, randomized and placebo-control
led design treatment with simvastatin (n = 8) for 36 weeks significant
ly reduced total cholesterol (6.7 +/- 0.3 vs 5.1 mmol.l-1 (p < 0.01)),
LDL-cholesterol (4.4 +/- 0.3 vs 2.9 +/- 0.2 mmol.l-1 (p < 0.01)) and
apolipoprotein B (1.05 +/- 0.04 vs 0.77 +/- 0.02 mmol.l-1 (p < 0.01))
levels as compared to placebo (n = 10). Both glomerular filtration rat
e (mean +/- SEM) (simvastatin: 96.6 +/- 8.0 vs 96.0 +/- 5.7 ml.min-1.1
.73 m-2, placebo: 97.1 +/- 6.7 vs 88.8 +/- 6.0 ml.min-1.1.73 m-2)(NS)
and urinary albumin excretion rate (geometric mean x/divided-by antilo
g SEM) (simvastatin: 18.4 x/divided-by 1.3 vs 16.2 x/divided-by 1.2 mu
g.min-1, placebo 33.1 x/divided-by 1.3 vs 42.7 x/divided-by 1.3 mug.mi
n-1)(NS) were unchanged during the study. A euglycaemic hyperinsulinae
mic clamp was performed at baseline and after 18 weeks in seven simvas
tatin- and nine placebo-treated patients. Isotopically determined basa
l and insulin-stimulated glucose disposal was similarly reduced before
and during therapy in both the simvastatin (2.0 +/- 0.1 vs 1.9 +/- 0.
1 (NS) and 3.1 +/- 0.6 vs 3.1 +/- 0.7 mg-kg-l.min-1 (NS)) and the plac
ebo group (1.9 +/- 0.1 vs 1.8 +/- 0.1 (NS) and 4.1 +/- 0.6 vs 3.8 +/-
0.2 mg.kg-1 .min-1 (NS)). No difference was observed in glucose storag
e or glucose and lipid oxidation before and after treatment. Further,
the suppression of hepatic glucose production during hyperinsulinaemia
was not influenced by simvastatin (-0.7 +/- 0.8 vs -0.7 +/- 0.5 mg.kg
-1.min-1 (NS)). In conclusion, despite marked improvement in the dysli
pidaemia simvastatin had no impact on kidney function or urinary album
in excretion rate and did not reduce insulin resistance in these micro
albuminuric and moderately hypercholesterolaemic Type 2 diabetic patie
nts.