Related Experiment Video
Updated: May 5, 2026
10:03
A Zebrafish Model of Diabetes Mellitus and Metabolic Memory
Published on: February 28, 2013
25.3K
Preventing microalbuminuria in type 2 diabetes.
Piero Ruggenenti1, Anna Fassi, Anelja Parvanova Ilieva
1Mario Negri Institute for Pharmacological Research, Clinical Research Center for Rare Diseases, Aldo e Cele Daccò, Villa Camozzi, Ranica, Bergamo, Italy. manuelap@marionegri.it
The New England Journal of Medicine
|November 2, 2004
Summary
Trandolapril, alone or with verapamil, significantly reduced microalbuminuria in patients with type 2 diabetes and hypertension. Verapamil alone showed no benefit over placebo in preventing this complication.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- The Bergamo Nephrologic Diabetes Complications Trial (BENEDICT) investigated preventative strategies for kidney complications in diabetic patients.
- Hypertension and type 2 diabetes mellitus are key risk factors for microvascular damage, including microalbuminuria.
Purpose of the Study:
- To evaluate the efficacy of angiotensin-converting-enzyme inhibitors (trandolapril) and non-dihydropyridine calcium-channel blockers (verapamil), alone or in combination, in preventing microalbuminuria.
- To assess the impact of these antihypertensive agents on the progression of kidney disease in diabetic patients with normal urinary albumin excretion.
Main Methods:
- A multicenter, double-blind, randomized trial involving 1204 subjects with hypertension, type 2 diabetes, and normoalbuminuria.
- Participants received trandolapril, verapamil, a combination of both, or placebo for at least three years, targeting a blood pressure of 120/80 mm Hg.
- The primary endpoint was the development of persistent microalbuminuria, defined as overnight albumin excretion ≥20 µg/min at two consecutive visits.
Main Results:
- Trandolapril plus verapamil (5.7%) and trandolapril alone (6.0%) significantly reduced the incidence of microalbuminuria compared to placebo (10.0%).
- Verapamil alone (11.9%) did not show a significant benefit over placebo (P=0.54).
- Trandolapril-containing regimens delayed the onset of microalbuminuria by factors of 2.6 (combination) and 2.1 (trandolapril alone). Serious adverse events were comparable across all groups.
Conclusions:
- Trandolapril, with or without verapamil, effectively decreases the incidence of microalbuminuria in patients with type 2 diabetes and hypertension who have normoalbuminuria.
- Verapamil monotherapy demonstrated no significant protective effect against microalbuminuria in this population.
- These findings highlight the renoprotective role of ACE inhibitors in diabetic hypertensive patients at early stages of kidney disease.
Related Concept Videos
01:22Diabetes Mellitus: Type 2 and Gestational
5.0K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
5.0K
01:15Diabetes: Management and Pharmacotherapy
1.5K
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
1.5K
01:26Oral Hypoglycemic Agents: Biguanides and Glitazones
998
Biguanides, particularly metformin (Glucophage), are insulin sensitizers that enhance glucose uptake, thereby reducing insulin resistance. Unlike sulfonylureas, metformin doesn't prompt insulin secretion, which helps to curb hypoglycemia risk. Metformin is beneficial in treating conditions like polycystic ovary syndrome due to its insulin-resistance reduction capability. The drug's primary action involves curtailing hepatic gluconeogenesis, a significant contributor to high blood...
998
01:25Type II Diabetes Mellitus III: Clinical Manifestations and Diagnosis
32
Type 2 diabetes mellitus develops gradually and is often asymptomatic in early stages.Clinical ManifestationsWhen symptoms appear, they include fatigue, blurred vision, pruritus, delayed wound healing, and recurrent infections, particularly candidal infections. Peripheral neuropathy may present as numbness or tingling in the extremities. Classic hyperglycemia symptoms—polyuria, polydipsia, and polyphagia—are less common. Most patients are overweight and frequently have associated...
32
01:27Diabetic Retinopathy
65
DefinitionDiabetic retinopathy is a microvascular complication of diabetes affecting the retinal blood vessels.Risk FactorsDiabetic retinopathy is present in almost all individuals with type 1 diabetes and more than 60% of those with type 2 diabetes after two decades of disease.The risk increases with poor glycemic control, hypertension, dyslipidemia, smoking, pregnancy, and puberty.Although cataracts and glaucoma are also more frequent in people with diabetes, retinopathy remains the leading...
65
01:28Diabetic Nephropathy
49
Definition Diabetic nephropathy is a chronic kidney complication that results from prolonged hyperglycemia.Prevalence It is the most common cause of chronic kidney disease (CKD) and end-stage renal disease (ESRD) worldwide, affecting up to half of individuals with diabetes.Pathophysiology • Sustained hyperglycemia triggers multiple hemodynamic and metabolic changes in the kidney. • Early in the disease, increased renal blood flow and glomerular hyperfiltration...
49