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DO ACE INHIBITORS PROMOTE HYPOGLYCEMIA IN DIABETIC PATIENTS?

A 1995 report suggested that angiotensin-converting enzyme (ACE) inhibitors increase the risk for hypoglycemia among diabetic patients taking insulin or oral agents (see JW Jun 15 1995, p. 94 and Lancet 1995; 345:1195). But that study was criticized on the grounds of inadequate adjustment for confounding factors.

This new case-control study from Scotland used a comprehensive community database to examine the association between ACE inhibitors and hospital admission for hypoglycemia among diabetic patients. After adjustment for variables such as overall glycemic control, renal function, diuretic therapy, and use of insulin versus oral drugs, the hypoglycemic patients were significantly more likely to have used ACE inhibitors than controls (odds ratio, 4.3). No such relation was found for beta-blockers or calcium antagonists.

Comment: One proposed mechanism for these findings is that ACE inhibitors may increase sensitivity to insulin. But like its predecessor, this study is not without problems (e.g., data on potential confounding variables were missing for some patients, and only hospital admissions for hypoglycemia were examined). Because so many diabetic patients take ACE inhibitors, this subject deserves further study.

— AS Brett

Published in Journal Watch General Medicine September 16, 1997

Citation(s):

Morris AD et al. ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. Diabetes Care 1997 Sep 20 1363-1367.

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