Evaluation of the effectiveness of diabetic nephropathy stage III in patients with type 2 diabetes mellitus therapy with sulodexide

Abstract

Introduction. Diabetes mellitus (DM) - takes the main place in the structure of endocrine diseases, and the third after cardiovascular and cancer pathology. In Ukraine 1.2 million of people suffer from diabetes and type 2 diabetes occurs in 85-90% of them. In 2004, 3.4 million of people died from diabetes complications. Diabetic nephropathy (DN) is a serious chronic complication of diabetes that leads to the formation of nodular or diffuse glomerulosclerosis. It is the most frequent cause of terminal chronic renal failure (CRF) in the world, accounting for over 25% of all cases of CRF. The generally accepted classification is Moggensen`s classification (1983, WHO), according to which five stages of diabetic nephropathy are identified, the first two stages of them are preclinical. Leading role in the pathogenesis of DN takes hyperglycemia, which is implemented by the phenomenon of glucosetoxicity. A lot of facts underscore the importance of inflammatory mechanisms triggered by cytokines. There's immune and non-immune theory of DN. The basis of non-immune theory is a violation of the synthesis of glycosaminoglycans (GAGs) that are a major component of the glomerular basement membrane (GMB). GAGs create its negative charge, which prevents the passage through the renal filter small negatively charged molecules, including albumin. In hemodynamic regulation leading role belongs to the renin-angiotensin-aldosterone system (RAAS). The blockade of the RAAS system with ACE inhibitors is the basis of a treatment strategy of DN. All mentioned above became a reason for study of the possibility of a new direction in the treatment of DN using the drug sulodexid, which is a natural mixture of GAGs. Objective of the research. Evaluating the effectiveness of sulodexide therapy of DN stage III in patients with type 2 diabetes. Materials and methods. The patients were divided into 2 groups. Group I consisted of 24 patients aged 40 to 68 years. 5 of them were women and 19 were men. In 20 patients from the group alimentary-constitutional obesity was noted. II group consisted of 11 people: 4 women and 7 men, aged 48 to 68 years, 6 of which were suffering from alimentary-constitutional obesity. Patients received standard treatment of type 2 diabetes and hypertension. In group I, sulodexide (600 LPL units intramuscularly 1 time per day for 10 days) was further included. The research of microalbuminuria (MAU) was conducted on admission and on the 10th day of treatment. Results. The initial values of MAU in 1st group were 92,7 ± 25,2 mcg/min. In the dynamics of monitoring rates decreased to 44,4 ± 9,6 mcg/min. The degree of decrease was 47% (p <0.05). In 2nd Group MAU initial values were 46,7 ± 23,4 mcg/min. In the dynamics of monitoring MAU decreased to 29,5 ± 12,6 mcg/min. Degree of decrease was 27% (p <0.05) Conclusions. 1) In patients with stage III DN with diabetes type 2 by including in the basic therapy of sulodexide level MAU was reliable decreased on 47%, which is on 20% lower than in the comparison group (p <0.05). 2) During the research reliable direct dependence of decreased MAU rates with its initial values and degree of obesity was found. It indicates the increase in the effectiveness of the drug at a higher initial level of MAU in people with overweight.

Keywords

• diabetes mellitus
• diabetic nephropathy
• sulodexide