Yonsei Med J.  2016 Jan;57(1):180-186. 10.3349/ymj.2016.57.1.180.

Impact of Angiotensin Converting Enzyme Inhibitor versus Angiotensin Receptor Blocker on Incidence of New-Onset Diabetes Mellitus in Asians

• Park JY
• Rha SW
• Choi BG
• Choi SY
• Choi JW
• Ryu SK
• Lee SJ
• Kim S
• Noh YK
• Akkala RG
• Li H
• Ali J
• Kim JB
• Lee S
• Na JO
• Choi CU
• Lim HE
• Kim JW
• Kim EJ
• Park CG
• Seo HS
• Oh DJ

• KMID: 2466368
• DOI: http://doi.org/10.3349/ymj.2016.57.1.180

Abstract

PURPOSE
Angiotensin converting enzyme inhibitor (ACEI) and angiotensin receptor blocker (ARB) are associated with a decreased incidence of new-onset diabetes mellitus (NODM). The aim of this study was to compare the protective effect of ACEI versus ARBs on NODM in an Asian population.
MATERIALS AND METHODS
We investigated a total of 2817 patients who did not have diabetes mellitus from January 2004 to September 2009. To adjust for potential confounders, a propensity score matched (PSM) analysis was performed using a logistic regression model. The primary end-point was the cumulative incidence of NODM, which was defined as having a fasting blood glucose > or =126 mg/dL or HbA1c > or =6.5%. Multivariable cox-regression analysis was performed to determine the impact of ACEI versus ARB on the incidence of NODM.
RESULTS
Mean follow-up duration was 1839+/-1019 days in all groups before baseline adjustment and 1864+/-1034 days in the PSM group. After PSM (C-statistics=0.731), a total 1024 patients (ACEI group, n=512 and ARB group, n=512) were enrolled for analysis and baseline characteristics were well balanced. After PSM, the cumulative incidence of NODM at 3 years was lower in the ACEI group than the ARB group (2.1% vs. 5.0%, p=0.012). In multivariate analysis, ACEI vs. ARB was an independent predictor of the lower incidence for NODM (odd ratio 0.37, confidence interval 0.17-0.79, p=0.010).
CONCLUSION
In the present study, compared with ARB, chronic ACEI administration appeared to be associated with a lower incidence of NODM in a series of Asian cardiovascular patients.

Keyword

Angiotensin converting enzyme inhibitor; angiotensin receptor blocker; diabetes mellitus

MeSH Terms

Adult
Aged
Angiotensin Receptor Antagonists/*therapeutic use
Angiotensin-Converting Enzyme Inhibitors/*therapeutic use
Asian Continental Ancestry Group/*statistics & numerical data
Blood Glucose/analysis
Diabetes Mellitus/*diagnosis/*epidemiology
Dose-Response Relationship, Drug
Drug Monitoring/methods
Female
Follow-Up Studies
Humans
Hypertension/*drug therapy
Incidence
Kaplan-Meier Estimate
Logistic Models
Male
Middle Aged
Multivariate Analysis
Propensity Score
Republic of Korea/epidemiology
Risk Factors
Angiotensin Receptor Antagonists
Angiotensin-Converting Enzyme Inhibitors
Blood Glucose

Figure

• 

  Fig. 1 Kaplan-Meier survival curves describing cumulative incidences of NODM in before and PSM. (A) Before PSM, Kaplan-Meier survival curves showed that the cumulative incidence of new-onset diabetes were significantly higher in the ARB group (black) than in the ACEI group (gray) (p=0.019, log-rank test). (B) After PSM, Kaplan-Meier survival curves showed that the cumulative incidence of new-onset diabetes were significantly higher in the ARB group (black) than in the ACEI group (gray) (p=0.012, log-rank test). NODM, new onset diabetes mellitus; PSM, propensity score matching; ARB, angiotensin II receptor blocker; ACEI, angiotensin converting enzyme inhibitor.

• 

  Fig. 2 Kaplan-Meier survival curves describing cumulative incidences of MACCE in before and PSM. (A) Before PSM, Kaplan-Meier survival curves showed that the cumulative incidence for MACCE were significantly higher in the ACEI group (gray) than in the ARB group (black) (p=0.014, log-rank test). (B) After PSM, Kaplan-Meier survival curves showed that the cumulative incidence for MACCE were similar between the ACEI group (gray) and the ARB group (black) (p=0.682, log-rank test). MACCE, major adverse cerebro-cardiovascular accidents; PSM, propensity score matching; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin II receptor blocker.

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