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Clinical Review

Prevention and early detection of vascular complications of diabetes

BMJ 2006; 333 doi: (Published 31 August 2006) Cite this as: BMJ 2006;333:475

Prevention of vascular complications in diabetes: only the modifications of risk factors or is need to use other drugs?

With regard to the outstanding clinical review by Marshall and
Flyvbjerg1, we would like to highlight an option to consider in the
management of patients with diabetes with Peripheral Artery Disease. Some
indications exist on the potential effectiveness of iloprost, a synthetic
prostacyclin analog with potent anti-aggregating and vasodilatory
properties, and able to modulate damage from ischemia-reperfusion 2.

Iloprost reduced rest pain, improved claudication and ulcer healing in 40-
60% of Peripheral Artery Disease, including Diabetic patients, and delayed
amputation in the majority of responding individuals3. Dubois and
colleagues 4 reported that in responders group, at 6 months, 96.5%
patients were alive without amputation compared to only 37% among non
responders. At one year, 79.3% of the responders and 31.4% of the non
responders were alive without amputation. The effects of iloprost on to
prevent vascular damage has been reported by Shindo et al5 that
demonstrated as iloprost reduced the urinary albumin excretion rate, the
urinary albumin-creatinine ratio and N-acetyl-beta-D-glucosaminidase
without decreasing creatinine clearance during the treatment period until
two weeks after.

Though not conclusive, these data seem to us of interest and iloprost an
additional, safe and effective therapeutic in Diabetic patients with
peripheral artery disease that merits to be systematically studied in this

Antonino Mazzone, M.D.

Department of Internal Medicine,
Hospital of Legnano, Italy

1. Marshall SM,Flyvbjerg A. Prevention and early detection of
vascular complications of diabetes.BMJ 2006;333:475-480.

2. de Donato G, Gussoni G, de Donato G. Mazzone A et al. The ILAILL study:
iloprost as adjuvant to surgery for acute ischemia of lower limbs. A
randomized, placebo-controlled double-blind study by the Italian Society
for Vascular and Endovascular Surgery. Ann Surg 2006; 244: 185-93

3. Grant SM, Goa KL Iloprost. A review of its pharmacodynamic properties,
and therapeutics potential in peripheral vascular disease myocardial
ischaemia and extraxorporeal circulation procedures. Drugs 2002;889-924.

4. Dubois S, Cailleux N, Benosman B, Levesque H. Tolerance of
iloprost and results of treatment of chronic severe lower limb ischaemia
in diabetic patients.A retrospective study of 64 consecutive cases.
Diabetes Metab 2003 29;36-43.

5. Shindo H, Tawata M, Yokomori N, Hosaka Y, Ohtaka M, Onaya T. Iloprost
decreases urinary albumin excretion rate in patients with diabetic
nephropathy. Diabetes Res Clin Pract 1993:21;115-22.

Competing interests:
None declared

Competing interests: No competing interests

07 September 2006
Antonino Mazzone
Chief of Department of Internal Medicine
Via Candiani 2 20205 Legnano Milano