Abstract
BackgroundAngiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARγ) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus.MethodsIn the respective cohort, a total of 492,530 subjects who initiated ARB treatment between January 2004 and December 2009 were identified from Taiwan National Health Insurance Database. The primary outcome was newly diagnosed diabetes, defined as at least one hospital admission or two or more outpatient visits within a year with an ICD-9-CM code 250. Cox proportional regression was used to estimate the risk of diabetes associated with each ARB, using losartan as the reference.ResultsA total of 65,358 incident diabetes cases were identified out of 1,771,173 person-years. Olmesartan initiators had a small but significantly increased risk of developing diabetes after adjusting for baseline characteristics and mean daily dose (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.03-1.12). After excluding those followed for less than one year, the increase in diabetes risk are more pronounced (HR, 1.09; 95% CI, 1.05-1.14). This association was consistent across all subgroup analyses. Similar results were observed when a more strict definition of diabetes combining both diabetes diagnosis and anti-diabetic treatment was used. On the other hand, there was no difference in diabetes risk between telmisartan and losartan.ConclusionsAmong all ARBs, olmesartan might be associated with a slightly increased risk of diabetes mellitus. Our data suggest differential diabetes risks associated with ARBs beyond a class effect.
Highlights
Angiotensin II type 1 receptor blockers (ARBs) are widely used for treatment of hypertension and congestive heart failure
Since there is currently no study comparing the risk of diabetes associated with individual Angiotension II type receptor blockers (ARB), the objective of this study was to assess the association of individual ARBs with newonset diabetes
Study population From the source population, we identified adult patients aged more than 20 years who initiated losartan, valsartan, irbesartan, candesartan, telmisartan, or olmesartan treatment between January 1, 2004 and December 31, 2009
Summary
Angiotensin II type 1 receptor blockers (ARBs) are widely used for treatment of hypertension and congestive heart failure. Several meta-analyses, randomised clinical trials or retrospective studies have demonstrated that ARBs use reduces diabetes risk in patients with hypertension or congestive heart failure as compared to other antihypertensive therapies or placebo [1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. The anti-diabetic action of ARBs appears to be complex, including activation of peroxisome proliferator-activated receptor-γ (PPARγ), suppression of oxidative stress, inhibition of fibrosis, and enhancement of insulin signalling [17,18]. Angiotensin receptor blockers (ARBs) have been shown to exert various peroxisome proliferator-activated receptor gamma (PPARγ) binding activities and insulin-sensitizing effects. The objective of this study was to investigate the association of different ARBs with new-onset diabetes mellitus
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