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High-dose thiamine and its lipid-soluble derivative benfotiamine inhibits the development of incipient nephropathy in a rat model of diabetes.
Dr. Paul J. Thornalley and colleagues at the University of Essex suggest that this may provide a novel strategy for preventing this complication in patients. Rats treated with streptozotocin to induce diabetes normally develop microalbuminuria and high glomerular filtration rates over 24 weeks when maintained on sub-optimal insulin therapy and diabetic rats have abnormally low plasma thiamine concentrations, they add.
Dr. Thornalley’s group found that adding thiamine and benfotiamine to the food of diabetic rats inhibited the development of microalbuminuria by 70% to 80%. Benfotiamine also delayed the onset of hyperfiltration.
Dr. Thornalley said that a significant proportion of patients with tight blood glucose control still develop nephropathy and other vascular complications.. "Since the thiamine response is independent of blood glucose control, it may well be beneficial to patients with both tight and conventionally controlled blood glucose."
He pointed out that previous studies suggest beneficial effects of thiamine and benfotiamine in preventing diabetic neuropathy and retinopathy. "In suppressing microalbuminuria, thiamine and benfotiamine may also be expected to have some benefit in decreasing the risk of macrovascular disease, such as heart disease and stroke," he added.
However, there is no evidence yet that high-dose thiamine therapy can prevent progression once early-stage nephropathy has already developed. "It may depend how damaged the kidney has become before dosing begins," he commented.
Dr. Thornalley and his associates hope to begin a small clinical intervention study early in 2004 "as a precursor to a full clinical trial to test if prevention of diabetic nephropathy can be demonstrated unequivocally." Diabetes 2003;52:2110-2119.
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