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Does interference with the renin-angiotensin system protect against diabetes? Evidence and mechanisms

N J van der Zijl1, C C M Moors, G H Goossens

  • 1Diabetes Center, Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands. nj.vdzijl@vumc.nl

Diabetes, Obesity & Metabolism
|January 10, 2012
PubMed

Insights

Agents blocking the renin-angiotensin system (RAS) reduce type 2 diabetes mellitus (T2DM) risk in hypertensive patients. This review explores how RAS blockade improves insulin sensitivity and beta-cell function, potentially delaying T2DM onset.

Area of Science:

  • Endocrinology
  • Cardiovascular Medicine
  • Metabolic Disorders

Background:

  • Hypertensive high-risk populations show reduced type 2 diabetes mellitus (T2DM) incidence with renin-angiotensin system (RAS) interfering agents compared to other antihypertensives.
  • Mechanisms for RAS blockade's protective effect on glucose metabolism are not fully elucidated.
  • T2DM involves beta-cell dysfunction and insulin resistance, particularly in obesity.

Purpose of the Study:

  • Review evidence from randomized controlled trials on RAS interference and T2DM.
  • Discuss proposed mechanisms for how RAS blockade may delay T2DM onset.
  • Address RAS blockade's impact on beta-cell function and insulin sensitivity.

Main Methods:

  • Review of randomized controlled trials (RCTs).
  • Discussion of proposed mechanistic pathways.
  • Focus on beta-cell function and insulin sensitivity.

Main Results:

  • RAS blockade demonstrates a protective effect against T2DM in hypertensive individuals.
  • Proposed mechanisms involve improvements in beta-cell function.
  • Proposed mechanisms involve improvements in insulin sensitivity.

Conclusions:

  • RAS interference, via ACE inhibitors or ARBs, may delay T2DM development.
  • Further research is needed to fully understand the mechanisms of RAS blockade on glucose metabolism.
  • RAS blockade shows potential for managing T2DM risk in high-risk populations.

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