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Angiotensin-converting enzyme inhibitor treatment for young normotensive diabetic subjects: a two-year trial
H P Chase1, S K Garg, S Harris
1Department of Pediatrics, University of Colorado Health Sciences Center, Denver.
Abstract:
Microangiopathy characterizes both diabetic retinopathy and nephropathy. It is currently unclear which diabetic subjects should be treated with angiotensin-converting enzyme (ACE) inhibitors. A double-blind, placebo-controlled protocol was implemented using captopril to treat subjects with Type I diabetes, early diabetic nephropathy (albumin excretion rates, 20-200 micrograms/min), and normal blood pressures. After two years, the final eye grades were improved in two treated subjects but not in any of the controls. Three control and one treated subject showed worsening of their eye grade after two years (P < .001, by chi-square test). Significant differences in renal albumin excretion were not seen between the two groups. The distribution of changes in retinal grades in the treatment group compared with the placebo group was improved after two years. Studies of larger numbers of patients will be necessary to determine if ACE inhibitors should be used routinely in subjects with diabetic retinopathy and to determine which subjects are most likely to respond.
Insights
Captopril, an angiotensin-converting enzyme (ACE) inhibitor, showed potential in improving diabetic retinopathy in Type I diabetes patients with early nephropathy. Further studies are needed to confirm its routine use and identify optimal responders.
Area of Science:
- Nephrology
- Ophthalmology
- Endocrinology
Background:
- Diabetic retinopathy and nephropathy share microangiopathy as a characteristic feature.
- The optimal use of angiotensin-converting enzyme (ACE) inhibitors in diabetic patients remains unclear.
- Type I diabetes with early nephropathy presents a specific cohort for investigating ACE inhibitor efficacy.
Purpose of the Study:
- To evaluate the efficacy of captopril, an ACE inhibitor, in treating diabetic retinopathy in patients with Type I diabetes and early nephropathy.
- To assess the impact of captopril on both retinal and renal microvascular complications.
- To determine if ACE inhibitors offer a therapeutic benefit in this specific diabetic population.
Main Methods:
- A double-blind, placebo-controlled study was conducted.
- Participants had Type I diabetes, early diabetic nephropathy (20-200 micrograms/min albumin excretion), and normal blood pressure.
- Captopril was administered to the treatment group, with a placebo group serving as a control over two years.
Main Results:
- Two captopril-treated subjects showed improved eye grades, while no control subjects did.
- Three control subjects and one treated subject experienced worsening eye grades (P < .001).
- No significant differences in renal albumin excretion were observed between the groups, but retinal grade changes favored the treatment group.
Conclusions:
- Captopril demonstrated a potential benefit in improving diabetic retinopathy in the studied cohort.
- The study suggests a possible role for ACE inhibitors in managing diabetic retinopathy, though not definitively for nephropathy in this group.
- Larger trials are required to confirm these findings and identify patient subgroups most likely to benefit from ACE inhibitor therapy.