Key result
ACEIs linked to ~87% lower risk of new-onset diabetes vs ARBs regardless of statin use.
Why the study?
Comparative studies on the risk of new-onset diabetes mellitus with ACEIs versus ARBs, regardless of hyperglycaemia-inducing statin use, were needed.
Does ACEIs reduce new-onset diabetes mellitus in patients prescribed ACEIs or ARBs for the first time compared to ARBs?
Cohort (n=11,703)
Yes
Does ACEIs reduce new-onset diabetes mellitus in patients prescribed ACEIs or ARBs for the first time compared to ARBs?
Effect estimate: HR 0.13 (with statin); HR 0.15 (without statin)
p-value: p=<0.001 (with statin); 0.009 (without statin)
In a retrospective cohort, initiation of ACE inhibitors was associated with a significantly lower risk of new-onset diabetes compared to ARBs, regardless of concomitant statin use.
ACEI initiation may lower NODM risk versus ARBs; hypothesis-generating and should not yet change practice.
WHAT IS KNOWN AND OBJECTIVES: Regardless of statin use, which is known to induce hyperglycaemia, comparative studies on the risk of new-onset diabetes mellitus (NODM) with angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin II receptor blockers (ARBs) are needed. This study evaluated the effects of ACEIs and ARBs on NODM in the clinical setting. METHODS: This retrospective cohort study utilized electronic medical record data from Seoul St. Mary's Hospital and Seoul National University Hospital from 2009 to 2012. Patients who were prescribed ACEIs or ARBs for the first time (irrespective of concomitant statin use) were followed up for 5 years. RESULTS AND DISCUSSIONS: A total of 11,703 patients were included, 24.9% (n = 2916) were taking ACEIs and 75.1% (n = 9189) were taking ARBs. Patients on ACEIs had a significantly lower incidence of NODM both with statin use (HR = 0.13, p < 0.001) and without (HR = 0.15, p = 0.009) than patients on ARBs. Age ≥60 years (HR = 1.49, p = 0.010), BMI ≥25 (HR = 1.96, p < 0.010), use of calcium channel blockers (HR = 1.47, p = 0.010), and diuretics (HR = 1.48, p = 0.010) were risk factors for NODM with statin use. WHAT IS NEW AND CONCLUSION: Patients taking ACEIs are less likely to develop NODM than patients taking ARBs, irrespective of statin use. Patients' conditions, including the risk of NODM, should be considered before prescribing ACEIs or ARBs. Future randomized clinical trials are needed to clarify further the relationship between ACEIs and ARBs and their effect on NODM.
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Shin et al. (2021) conducted a cohort in Patients prescribed ACEIs or ARBs for the first time (n=11,703). Angiotensin-converting enzyme inhibitors (ACEIs) vs. Angiotensin II receptor blockers (ARBs) was evaluated on New-onset diabetes mellitus (NODM) (HR 0.13 (with statin); HR 0.15 (without statin), p=<0.001 (with statin); 0.009 (without statin)). ACEIs were associated with a significantly lower incidence of new-onset diabetes mellitus compared to ARBs, both with (HR 0.13, p<0.001) and without (HR 0.15, p=0.009) concomitant statin use.
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