Can N acetyl cysteine - Taurine provide additional reduction in microalbuminuria in type 2 diabetic patients already on optimum doses of Angiotensin converting enzyme inhibitors?

BACKGROUND: Usage of either angiotensin converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB) with or without dual channel calcium blockers (DCCB) is the standard recommendation for prevention of progression of micro to macro albuminuria and diabetic nephropathy (DN); however, these agents have their limitations. Animal studies with taurine and N-acetyl cysteine (NAC) have demonstrated additional reduction of microalbuminuria (MA).OBJECTIVES: To know whether the combination of NAC and taurine would additionally reduce MA and transforming growth factor β (TGF β) expression in T2 diabetics who are already on optimal doses of either ACEI or ARB and/or DCCB, and to know the effect of this combination on glycated hemoglobin (HbA1c), blood pressure (BP), lipid parameters, and estimated glomerular filtration rate (e-GFR).MATERIALS AND METHODS: Eighty diabetics, having MA, who were already on optimum doses of ARB or ACEI and or DCCB were recruited. Fifty were allocated to the test group and 30 were in the control group. All were examined with their height, weight, body mass index, waist circumference, and BP was measured initially and at the end of 3 months. The test group was administered NAC + taurine tablets, one tablet daily for 3 months and placebo was given to the control group. HbA1c, lipid profile, serum creatinine, MA, TGF β and e-GFR were estimated before and on completion of the study. ANOVA and Pearson's correlation were employed for statistical analysis.RESULTS: Forty-one in the test group and 21 in the placebo group completed the study. The test group did show reduction in MA and TGF β. MA reduced from 161.75 ± 120.38 mcg to 138.42 ± 153.60 mcg. TGF β decreased from 15.69 ± 9.16 to 12.68 ± 8.02 and both were not statistically significant. There was no change in serum creatinine and e-GFR. The drug did not have any significant effect on lipids, HbA1c, and BP.CONCLUSIONS: The combination of NAC + taurine provides additional reduction in MA and TGF β in those on ARB or ACEI with or without DCCB. The drug may thus be beneficial to those who have reached maximum reduction of MA with the other molecules. TGF β reduction is also a bonus which may postpone nephropathy. Further studies with larger recruits and increased doses may show statistically significant results.