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Quinapril and Losartan Effectively Treat Diabetic Autonomic Neuropathy, Improve Left Ventricular Function: Presented at EASD
By Thomas S. May
Special to DG News
BUDAPEST, HUNGARY -- September 4, 2002 -- Quinapril and losartan -- alone or in combination with each other -- appear to effectively reduce the symptoms of diabetic autonomic neuropathy and improve left ventricular function.
The findings were presented here September 3rd at the 38th annual meeting of the European Association for the Study of Diabetes (EASD).
Diabetic autonomic neuropathy and heart failure are major complications of diabetes mellitus, contributing to overall morbidity and mortality, explained lead author Dr. Triantafillos Didangelos, of Aristotelian University, in Thessaloniki, Greece.
His team investigated the effects of three regimens on diabetic autonomic neuropathy and diastolic left ventricular dysfunction -- the regimens were quinapril, an angiotensin converting enzyme inhibitor; losartan, an angiotensin II receptor blocker; and a combination of both drugs.
They enrolled 33 women and 23 men with diabetic autonomic neuropathy, 22 of them with type 1 diabetes mellitus. Patients were 51.7±13.9 years of age and had a duration of diabetes mellitus of 17.8±7.3 years. Patient with coronary artery disease or heart failure were excluded from the study.
They were randomly assigned to one of three groups: group A (n=15) received 20 mg quinapril (Q); group B (n=23) received 100 mg losartan (L); and group C (n=18) received 20 mg Q plus 50 mg L.
After 12 months of treatment, all three groups achieved improvements in symptoms of both diabetic autonomic neuropathy and diastolic left ventricular dysfunction.
In group A, improvements were observed in expiration/inspiration ratio (E/I) during deep breathing from 1.11±0.06 to 1.21±0.01; first third filling fraction (1/3FF) from 39.2±12.9 to 48.9±17.8 percent; and atrial contribution to ventricular filling (A/V) from 29.2±10.1 to 24.5±6.8 percent.
In group B, improvement was noted in E/I from 1.08±0.06 to 1.12±0.08; and 1/3FF from 39.9±17.1 to 45.3±17.6. In group C, improvements occurred in E/I from 1.08±0.04 to 1.15±0.09; and 1/3FF from 29.6±11.9 to 39.4±11.8 percent. These results were statistically significant at the p=0.05 level.
"Our results were encouraging, showing improvement of both diabetic autonomic neuropathy and diastolic left ventricular dysfunction. This may be of clinical importance for the long term prognosis of patients with diabetes mellitus, by preventing or delaying these complications," Dr. Didangelos said. "However, further studies are needed to establish the effectiveness of this kind of treatment," he cautioned.
The research was funded internally, with no financial support from the pharmaceutical industry.
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