Short Communication

Diabetologia

, Volume 52, Issue 2, pp 208-212

First online:

High-dose thiamine therapy for patients with type 2 diabetes and microalbuminuria: a randomised, double-blind placebo-controlled pilot study

  • N. RabbaniAffiliated withClinical Sciences Research Institute, Warwick Medical School, University of Warwick, University Hospital
  • , S. S. AlamAffiliated withDepartment of Pharmacology, Sheikh Zayed Federal Postgraduate Medical Institute, Sheikh Zayed Hospital
  • , S. RiazAffiliated withDepartment of Microbiology and Molecular Genetics, University of the Punjab
  • , J. R. LarkinAffiliated withClinical Sciences Research Institute, Warwick Medical School, University of Warwick, University Hospital
  • , M. W. AkhtarAffiliated withSchool of Biological Sciences, University of the Punjab
  • , T. ShafiAffiliated withDepartment of Nephrology, Division of Medicine, Sheikh Zayed Federal Postgraduate Medical Institute
  • , P. J. ThornalleyAffiliated withClinical Sciences Research Institute, Warwick Medical School, University of Warwick, University Hospital Email author 

Abstract

Aims/hypothesis

High-dose supplements of thiamine prevent the development of microalbuminuria in experimental diabetes. The aim of this pilot study was to assess whether oral supplements of thiamine could reverse microalbuminuria in patients with type 2 diabetes.

Methods

Type 2 diabetic patients (21 male, 19 female) with microalbuminuria were recruited at the Diabetes Clinic, Sheikh Zayed Hospital, Lahore, Pakistan, and randomised to placebo and treatment arms. Randomisation was by central office in sequentially numbered opaque, sealed envelopes. Participants, caregivers and those assessing the outcomes were blinded to group assignment. Patients were given 3 × 100 mg capsules of thiamine or placebo per day for 3 months with a 2 month follow-up washout period. The primary endpoint was change in urinary albumin excretion (UAE). Other markers of renal and vascular dysfunction and plasma concentrations of thiamine were determined.

Results

UAE was decreased in patients receiving thiamine therapy for 3 months with respect to baseline (median −17.7 mg/24 h; p < 0.001, n = 20). There was no significant decrease in UAE in patients receiving placebo after 3 months of therapy (n = 20). UAE was significantly lower in patients who had received thiamine therapy compared with those who had received placebo (30.1 vs 35.5 mg/24 h, p < 0.01) but not at baseline. UAE continued to decrease in the 2 month washout period in both groups, but not significantly. There was no effect of thiamine treatment on glycaemic control, dyslipidaemia or BP. There were no adverse effects of therapy.

Conclusions/interpretation

In this pilot study, high-dose thiamine therapy produced a regression of UAE in type 2 diabetic patients with microalbuminuria. Thiamine supplements at high dose may provide improved therapy for early-stage diabetic nephropathy.

Trial registration: CTRI (India) CTRI/2008/091/000112

Funding: Pakistan Higher Education Commission

Keywords

Diabetic complications Diabetic nephropathy Microalbuminuria Thiamine Type 2 diabetes