Abstract
Tocotrienol-rich vitamin E from palm oil (Tocovid) has been shown to ameliorate diabetes through its superior antioxidant, antihyperglycemic, and anti-inflammatory properties in diabetic rats. This study aimed to investigate the effects of Tocovid on diabetic nephropathy in patients with type 2 diabetes. Baseline parameters of potential subjects such as HbA1c, blood pressure, Advanced Glycation Endproduct (AGE), soluble receptor for AGE (sRAGE), Nε-Carboxymethyllysine (Nε-CML), and Cystatin C were assessed for possible correlation with diabetic nephropathy. Only subjects with diabetic nephropathy or urine microalbuminuria-positive defined as Urine Albumin to Creatinine Ratio (UACR) >10 mg/mmol were recruited into a prospective, randomized, double-blinded, placebo-controlled trial. The intervention group (n = 22) received Tocovid 200 mg twice a day while the control group (n = 23) received placebo twice a day for 8 weeks. Changes in Hemoglobin A1c (HbA1c), blood pressure, serum biomarkers and renal parameters such as UACR, serum creatinine, and estimated Glomerular Filtration Rate (eGFR) were compared between the two groups. It was found that serum Nε-CML significantly correlated to the severity of microalbuminuria. For every 1 ng/mL increase in serum Nε-CML, the odds of diabetic nephropathy increased by 1.476 times. Tocovid, compared to placebo, significantly reduced serum creatinine but not eGFR, UACR, HbA1c, blood pressure, and serum biomarkers. In conclusion, serum Nε-CML is a potential biomarker for diabetic nephropathy. Treatment with Tocovid significantly reduced serum creatinine; therefore Tocovid may be a useful addition to the current treatment for diabetic nephropathy.
Highlights
Diabetes is a major global health crisis of the 21st century
Treatment with Tocovid significantly reduced serum creatinine; Tocovid may be a useful addition to the current treatment for diabetic nephropathy
Tocovid significantly reduced serum creatinine compared to placebo (−11.28 umol/L ± 4.31, p = 0.014) despite adjustment for baseline value of serum creatinine, Hemoglobin A1c (HbA1c), systolic blood pressure (SBP), diastolic blood pressure (DBP), age, weight, Advanced Glycation Endproduct (AGE), CML, soluble receptor for AGE (sRAGE), and Cystatin C
Summary
Diabetes is a major global health crisis of the 21st century. The number of people affected by diabetes quadrupled from 108 million people in 1980 to a staggering figure of 422 million people worldwide in 2014 [1]. One of the major complications of diabetes is diabetic nephropathy, the leading cause of end stage renal failure (ESRF) worldwide. Renal replacement therapies, such as dialysis or kidney transplant, are needed in order for patients with ESRF to survive [2]. ESRF has affected 2 million people globally, with a rapid growth rate of approximately 5–7% per year [3]. Patients with diabetic nephropathy have increased risk of cardiovascular disease (CVD)
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