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: 30.475.3 kg/m 2 , HbA1c: 7.171.4%, serum creatinine: 172.4757.5 mmol/l, urinary protein: 3.372.6 g/day). RESULTS: The mean body weight decreased by 6.273.0 kg. The mean systolic blood pressure, creatinine, blood urea nitrogen, urinary protein, and 8-hydroxydeoxyguanosine decreased significantly by 7.5712.7 mmHg, 41.6723.9 mmol/l, 1.5071.61 mmol/l, 1.871.7 g/day, and 3.173.6 ng/mg creatinine, respectively. No patient had increased serum creatinine and urinary protein. Mean creatinine clearance (40.6717.9 to 46.1714.6 ml/s/1.73 m 2 ) and serum albumin showed no significant changes. Dserum creatinine and Durinary protein correlated with Dbody weight (r ¼ 0.62 and 0.49, respectively) and Dvisceral fat area (r ¼ 0.58 and 0.58, respectively), but did not correlate with Dsystolic blood pressure, Dfasting blood glucose and Dsubcutaneous 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.

Aim:The three types of calcium channel blocker (CCB), L-, T-and N-type, possess heterogeneous actions on endothelial function and renal microvascular function. In the present study, we evaluated the effects of two CCBs, efonidipine and amlodipine, on renal function and arterial stiffness. Methods: Forty type 2 diabetic patients with hypertension and nephropathy receiving angiotensin receptor blockers were enrolled and randomly divided into two groups: the efonidipine group was administered efonidipine hydrochloride ethanolate 40 mg/day and the amlodipine group was administered amlodipine besilate 5 mg/day for 12 months. Arterial stiffness was evaluated by the cardioankle vascular index (CAVI). Results: Changes in blood pressure during the study were almost the same in the two groups. Significant increases in serum creatinine and urinary albumin and a significant decrease in the estimated glomerular filtration rate were observed in the amlodipine group, but not in the efonidipine group. On the other hand, significant decreases in plasma aldosterone, urinary 8-hydroxy-2'-deoxyguanosine and CAVI were observed after 12 months in the efonidipine group, but not in the amlodipine group. Conclusions: These results suggest that efonidipine, which is both a T-type and L-type calcium channel blocker, has more favorable effects on renal function, oxidative stress and arterial stiffness than amlodipine, an L-type calcium channel blocker. J Atheroscler

Aim: Previous reports indicate that serum lipoprotein lipase mass levels (LPL mass) and common carotid artery intima-media thickness (CCA-IMT) are independent predictors of atherosclerotic diseases. The aim of this study was to examine the effects of combination therapy of sulfonylurea and acarbose on LPL mass and CCA-IMT. Methods: Eighty-four patients with type 2 diabetes mellitus, who were treated with only sulfonylureas and showed CCA-IMT of more than 0.9 mm at baseline, were selected and randomly divided into two groups. One group was administered acarbose 300 mg/day for 12 months (acarbose group, n 41), and the other group was not administered acarbose (non-acarbose group, n 43). Results: After 12 months, a significant increase in LPL mass and a significant decrease in CCA-IMT were observed in the acarbose group (1.024 to 0.964 mm), but no significant changes were observed in the non-acarbose group. In a subgroup analysis of patients with HbA1c improved by 0.5% or more, the increase of LPL mass and decrease of CCA-IMT was significantly greater in the acarbose group than in the non-acarbose group although the changes in HbA1c were similar in two groups. Conclusions: We concluded that reducing postprandial hyperglycemia might increase LPL mass levels and might be useful to prevent macroangiopathy in type 2 diabetic patients treated by sulfonylurea.

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