The estimation of nephroprotective effect of combined lipid-lowering therapy in decompensated type 2 diabetes

Abstract

Target. To evaluate the comparative nephroprotective efficacy of statin monotherapy and combined lipid-lowering therapy in patients with decompensated type 2 diabetes mellitus. Material and methods. The study included 68 patients with type 2 diabetes mellitus in the stage of decompensation who did not receive lipid-lowering therapy. All patients were randomized into three comparable groups. Patients of the first group (26 people) were prescribed simvastatin at a dose of 40 mg / day for 6 months. In 18 patients of the second group, combined therapy with simvastatin (40 mg / day) and ezetimibe (10 mg / day) was carried out. In 24 patients of the third group, lipid-lowering therapy was not prescribed. All patients were determined by the parameters of the lipid spectrum and liver function, the glomerular filtration rate and the severity of microalbuminuria. Studies were carried out before the start of treatment and 6 months after its completion. Results. A significant improvement in the parameters of the lipid spectrum in patients with diabetes mellitus was shown at the beginning of treatment during the decompensation period both with simvastatin monotherapy and combined treatment with simvastatin and ezetimibe, manifested in a decrease in total cholesterol, low-density lipoprotein cholesterol, triglycerides and atherogenic index, as well as a slight increase in high-density lipoprotein cholesterol levels. At the same time, a more pronounced decrease in low-density lipoprotein cholesterol was noted from 4.42 ± 0.27 to 3.01 ± 0.23 mmol / L with combined treatment compared with simvastatin monotherapy (from 3.58 ± 0.29 to 3.14 ± 0.16 mmol / L). Triglyceride levels decreased by 15.4% with monotherapy versus 30.6% with combination therapy. Lipid-lowering therapy was accompanied by a significant increase in the glomerular filtration rate in combined treatment from 91.61 ± 7.74 to 107.18 ± 8.35 ml / min / 1.73 m². A decrease in microalbuminuria was observed both with mono- and combined therapy, but the degree of its decrease with combination therapy was significantly greater, amounting to 32.4% compared to 17.6% with simvastatin monotherapy. Assessment of the functional state of the liver confirmed the safety of lipid-lowering therapy in patients with decompensated type 2 diabetes mellitus. Conclusion. In patients with diabetes mellitus of the second type, the beginning of treatment during the period of decompensation leads to the normalization of the blood lipid spectrum, which is manifested in a decrease in total cholesterol and the atherogenic index. Moreover, more significant changes are observed with combined lipid-lowering therapy. In addition, the combined treatment is accompanied by a greater severity of the nephroprotective effect. initiation of treatment during the decompensation period is safe and does not affect liver function indicators.