Clinical studies with CE-inhibitors in diabetes
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K Rett1, M Wicklmayr, G Dietze
1IIIrd Medical Department Krankenhaus Schwabing, Bühlerhöhe, Germany.
Abstract:
Early antihypertensive intervention in diabetes often means intervention in a cluster of cardiovascular risk factors including glucose intolerance per se, hyperlipidemia, obesity and hypertension, which are not just coexistent but may be causally linked together by the resistance of peripheral tissues to the action of insulin. Blood pressure lowering treatment should therefore be metabolically neutral in order to avoid aggravation of this risk factor syndrome. Clinical studies applying CE-inhibitors in type II diabetes are critically reviewed under this aspect. The majority of the available studies in type II diabetes report a reduction of insulin resistance and a marginal improvement of metabolic control. The order of magnitude in HbA1 reduction is nearly 10% of the glycosylated haemoglobin, reduction of fasting and postprandial blood glucose approximates 1 mmol/l. From a more extended view, considering essential hypertension as insulin resistant and thus possibly "prediabetic" state, this marginal metabolic effect gets further support from recent studies in essential hypertension consistently reporting an improvement of metabolic parameters of similar magnitude. This might become a central argument in the discussion about individualized and metabolically neutral antihypertensive treatment in essential hypertension.
Insights
Angiotensin-converting enzyme inhibitors (CE-inhibitors) may improve metabolic control in patients with type II diabetes by reducing insulin resistance. This finding supports their use as a metabolically neutral antihypertensive treatment option.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Early antihypertensive intervention in diabetes often involves managing multiple cardiovascular risk factors.
- These factors, including glucose intolerance, hyperlipidemia, obesity, and hypertension, may be linked by insulin resistance.
- Antihypertensive treatments should ideally be metabolically neutral to avoid worsening this risk factor cluster.
Purpose of the Study:
- To critically review clinical studies on CE-inhibitors in type II diabetes.
- To assess the metabolic neutrality and effects of CE-inhibitors in this patient population.
Main Methods:
- Review of clinical studies applying CE-inhibitors in type II diabetes patients.
- Analysis of reported effects on insulin resistance and metabolic control parameters.
Main Results:
- Most studies show CE-inhibitors reduce insulin resistance and marginally improve metabolic control in type II diabetes.
- HbA1c levels decreased by approximately 10%, and fasting/postprandial blood glucose by ~1 mmol/l.
- Studies in essential hypertension also indicate metabolic improvements, supporting CE-inhibitors' neutrality.
Conclusions:
- CE-inhibitors demonstrate a beneficial effect on insulin resistance and metabolic control in type II diabetes.
- Their metabolically neutral profile makes them a suitable option for antihypertensive therapy in diabetic patients.
- Findings support considering CE-inhibitors for individualized, metabolically neutral treatment in essential hypertension.