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Losartan modifies glomerular hyperfiltration and insulin sensitivity in type 1 diabetes.
S Nielsen1, K Y Hove, J Dollerup
1Medical Department M (Endocrinology and Diabetes), Aarhus Kommunehospital, Aarhus, Denmark. Nielsen.Soren@dadlnet.dk
Diabetes, Obesity & Metabolism
|March 21, 2002
Summary
Losartan treatment in type 1 diabetes patients significantly lowered blood pressure and improved glucose oxidation rates. Renal haemodynamics were affected, but insulin-mediated glucose disposal remained unchanged.
Area of Science:
- Nephrology
- Endocrinology
- Pharmacology
Background:
- Type 1 diabetes is associated with renal haemodynamic alterations and impaired glucose metabolism.
- Angiotensin II receptor blockers (ARBs) like losartan are used to manage hypertension and protect kidneys.
- The specific effects of losartan on renal haemodynamics and glucose metabolism in normotensive, normoalbuminuric type 1 diabetic patients require further elucidation.
Purpose of the Study:
- To investigate the impact of losartan on renal haemodynamics and insulin-mediated glucose disposal.
- To assess changes in blood pressure, glomerular filtration rate (GFR), renal plasma flow (RPF), and urinary albumin excretion rate (UAE).
- To evaluate the effect of losartan on glucose oxidation and disposal rates during basal and insulin-stimulated conditions.
Main Methods:
- A double-blind, placebo-controlled, cross-over study was conducted in nine normotensive, normoalbuminuric type 1 diabetic patients.
- Participants received either losartan (50 mg/day) or placebo for six weeks.
- Measurements included diurnal blood pressure, GFR, RPF, UAE, and hyperinsulinaemic euglycaemic clamp with indirect calorimetry.
Main Results:
- Losartan significantly reduced diurnal blood pressure and decreased GFR and filtration fraction (FF) compared to placebo.
- Renal plasma flow (RPF) and urinary albumin excretion rate (UAE) did not change significantly.
- While overall glucose disposal rates were similar, losartan significantly improved basal and insulin-stimulated glucose oxidation rates.
Conclusions:
- Losartan effectively reduces blood pressure and markers of glomerular hyperfiltration (GFR and FF) in type 1 diabetic patients.
- The drug enhances both basal and insulin-stimulated glucose oxidation.
- These findings suggest potential benefits of losartan in managing renal haemodynamics and improving metabolic parameters in this patient population.