Spironolactone and glucose metabolism, a systematic review and meta-analysis of randomized controlled trials

Diabetes predicts cardiovascular disease (CVD); some drugs are effective for CVD prevention but increase the risk of diabetes. In a systematic review and meta-analysis of placebo-controlled trials, we assessed if spironolactone, a mineralocorticoid receptor antagonist, affected glycemic control. We searched PubMed using ("spironolactone" or "aldactone") and trial and ("glucose" or "diabetes" or "insulin" or "insulin resistance") until January 4, 2016. In total, 18 eligible trials were identified; 10 on fasting glucose, 8 on hemoglobin A1c (HbA1c), 7 on homeostatic model assessment (HOMA)-insulin resistance (IR), and 8 on insulin. Spironolactone increased HbA1c (0.16%, 95% confidence interval 0.02 to 0.30) but had no clear effect on fasting glucose, HOMA-IR, and insulin. A mechanistic randomized controlled trial in people with and without diabetes might provide insight concerning these pleiotropic effects on diabetes and CVD relevant to prevention of both diseases.