Comparison of the effects of picotamide and aspirin on renal albumin excretion and cutaneous microcirculation in patients with type II diabetes mellitus: a pilot study

Abstract

We compared the effects of two antiplatelet agents, picotamide, a dual antithromboxane inhibitor, and aspirin, a nonselective cyclooxygenase inhibitor, on microalbuminuria and cutaneous microcirculation in diabetic patients. Twenty patients with type II diabetes mellitus with micro- or macroalbuminuria (urinary albumin excretion rate ⩾ 30 mg/24 h) (8 men, 12 women; mean age, 62 ± 3 years) were enrolled in an open-label, 3-month pilot study and randomly assigned to receive picotamide 300 mg twice daily (10 patients), or aspirin 325 mg/day (10 patients). The 24-hour urinary albumin excretion rate was measured at baseline and after 3 months using a commercial radioimmunoassay kit. Cutaneous microcirculation was assessed at the same time by means of laser-Doppler flowmetry. Supine resting flow (RF) and standing flow (SF) (after 3 minutes in the upright position) were also measured. The arteriovenous response (AVR) was calculated as (RF — SF)/RF × 100. The microangiopathy index (MI) was expressed as the ratio AVR:RF. Urinary albumin excretion rate increased significantly ( P < 0.05) as compared with baseline in the aspirin group (from 920 to 1073 mg/24 h), whereas it decreased slightly in the picotamide group (from 766 to 722 mg/24 h; P = not significant). Urinary albumin excretion rate increased in 6 patients in the aspirin group and in 1 patient in the picotamide group ( P < 0.05, chi-square test). MI worsened significantly ( P < 0.05) in the aspirin group (from −1275 at baseline to −1723 at month 3; in the picotamide group, MI improved significantly ( P < 0.01) from −1675 at baseline to −230 at month 3. As compared with aspirin, picotamide appears to halt the progression of renal albumin excretion and to improve cutaneous circulation in patients with type II diabetes mellitus who have incipient or overt nephropathy.