Endocrine Abstracts

Large scale clinical studies and meta-analysis suggest that treatment with angiotensin receptor blockers (ARBs) and angiotensin converting enzyme inhibitors (ACEIs) could have protective effect against diabetes development. While diuretics and β-blockers have some well known adverse effect on glycaemic regulation, ARBs/ACEIs’ effect on glucose regulation in patients already diagnosed with diabetes has not been investigated well enough. Also to the best of our knowledge, direct comparison between ARBs and ACEIs for glycaemic control has not been investigated as well. The aim of this study is to compare the effect of ARBs and ACEIs on glucose regulation in a diabetic population. All subjects were randomly selected using their electronic records. While 37% (n=39) of the study population were using ACEIs, the remaining 63% (n=67) were using ARBs as monotherapy or in combination. Patients who are under monotherapy for hypertension with ARBs or ACEIs were found to be similar (20.5 and 19.4%, P=0.89). Mean follow-up duration of the whole study population was 44.3±35.4 (6–139) months with a median of 4 (2–7) HbA1c measurements per se. The mean age of the whole study population was 66.8±11.6 (31–93) years. Mean diabetes duration was 10.5±8.9 (1–49) years. All statistical comparisons were made by adjusting both groups according to age, gender, diabetes duration, and medication for diabetes (metformin, sulphonylurea, and insulin), smoking habits, β-blocker, diuretic, and statin use. When comparing subjects using ARB with those on ACEIs, we found that ARB treatment is related to significantly lower mean HbA1c level (7.1 and 6.7%, P=0.028). Although the population of this study group is not sufficient to make larger scale conclusions, we anticipate that patients with diabetes will benefit more from ARBs rather than ACEIs in regard to glucose control. The reason may be related to the type of mechanisms of drugs action and degree of angiotensin II blockade.