Key result
Olmesartan initiation was associated with a small but increased risk of developing new-onset diabetes compared to losartan.
Why the study?
Does the choice of specific ARB (e.g., olmesartan, telmisartan) alter the incidence of new-onset diabetes compared to losartan in adult patients?
Cohort (n=492,530)
Does the choice of specific ARB (e.g., olmesartan, telmisartan) alter the incidence of new-onset diabetes compared to losartan in adult patients?
Olmesartan is associated with a slightly increased risk of new-onset diabetes compared to losartan, suggesting heterogeneous metabolic effects among ARBs beyond a class effect.
Answers are grounded in this paper and cite their sources.
Should not yet change ARB selection; leaves open possible metabolic heterogeneity among ARBs on new-onset diabetes.
BACKGROUND: 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. METHODS: In 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. RESULTS: A 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. CONCLUSIONS: Among 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.
No takes yet. Share an insight, caveat, or question.
Chang et al. (2014) conducted a cohort in Patients initiating angiotensin receptor blockers (n=492,530). Olmesartan vs. Losartan was evaluated on Newly diagnosed diabetes (at least one hospital admission or two or more outpatient visits within a year with ICD-9-CM code 250) (HR 1.07, 95% CI 1.03-1.12). Olmesartan initiation was associated with a small but increased risk of developing new-onset diabetes compared to losartan.
Synapse has enriched 10 related papers. Consider them for comparative context: