Elsevier

The Lancet

Volume 345, Issue 8959, 13 May 1995, Pages 1195-1198
The Lancet

Hypoglycaemia associated with use of inhibitors of angiotensin converting enzyme

https://doi.org/10.1016/S0140-6736(95)91988-0Get rights and content

Abstract

The use of angiotensin-converting-enzyme (ACE) inhibitors has been associated with increased insulin sensitivity in diabetic patients. Although such an effect could be beneficial in the treatment of hypertension or congestive heart failure in diabetic patients, it might also precipitate severe hypoglycaemia. To test this hypothesis we carried out a nested case-control study, using data in the Dutch PHARMO system (1986-92), among diabetic patients treated with insulin or with oral antidiabetic drugs, who were admitted to hospital with hypoglycaemia. We identified 94 patients who had been admitted with hypoglycaemia and selected 654 controls from the same cohort. With adjustment for a wide range of potential confounding factors, hypoglycaemia was significantly associated with current use of ACE inhibitors (odds ratio 2·8 [95% Cl 1·4-5·7]). Both among users of insulin and among users of oral antidiabetic drugs, use of ACE inhibitors was significantly associated with an increased risk of hospital admission for hypoglycaemia (2·8 [1·2-6·4] and 4·1 [1·4-12·2], respectively). Although ACE inhibitors have several advantages over other antihypertensive drugs in diabetes, the risk of hypoglycaemia should be taken into account. Further investigation of the mechanism is needed since as many as 13·8% of all hospital admissions for hypoglycaemia might be attributable to use of ACE inhibitors.

References (20)

  • Sg Allan et al.

    Captopril, enalapril, and blood glucose

    Lancet

    (1986)
  • C. Aruaz-Pachecho et al.

    Hypoglycaemia induced by angiotensin-converting enzyme inhibitors in patients with non-insulin-dependent diabetes receiving sulfonylurea therapy

    Am J Med

    (1990)
  • K. Rett et al.

    Hypoglycaemia in hypertensive diabetic patients treated with sulfonylureas, biguanidines, and captopril

    N Engl J Med

    (1988)
  • M. Ferriere et al.

    Captopril and insulin sensitivity

    Ann Intern Med

    (1985)
  • P. Winocur et al.

    Captopril and blood glucose

    Lancet

    (1986)
  • P. Passa et al.

    Effects of enalapril in insulin-dependent diabetic subjects with mild to moderate uncomplicated hypertension

    Diabetes Care

    (1987)
  • T. Seefeldt et al.

    Lack of effects of angiotensin-converting enzyme (ACE)-inhibitors on glucose metabolism in type 1 diabetes

    Diabetic Med

    (1990)
  • G. Sieghieri et al.

    Effect of chronic ACE inhibition on glucose tolerance and insulin sensitivity in hypertensive type 2 diabetic patients

    Diabetic Med

    (1992)
  • A. Oksa et al.

    Effects of angiotensin-converting enzyme inhibitors on glucose and lipid metabolism in essential hypertension.

    J Cardiovasc Pharmacol

    (1992)
There are more references available in the full text version of this article.

Cited by (0)

View full text