Henry Ford Health System, Detroit, MI, USA.
Cardiol J. 2010;17(5):448-56.
The prevalence of diabetes mellitus (DM) has increased exponentially in recent years, with 100 million people expected to develop diabetes in the coming 15 years. The impact of medical therapy on the incidence of new onset DM is not clear. We performed a systematic review and meta-analysis to study the impact of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin receptor blockers (ARBs) on the incidence of new onset DM.
MEDLINE, EMBASE, BIOSIS, Cochrane databases from inception until February 2009 for randomized controlled trials (RCT) that reported new incident DM with ACEI or ARB therapy. A total of 18 RCT are included in this meta-analysis. A random-effect model was used and between-studies heterogeneity was estimated with I(2).
There were 50,451 patients randomized to ACEI or ARB and 50,397 patients randomized to other therapies. ACEI/ARB use was associated with a decrease in new onset DM (RR 0.78, 95% CI 0.70-0.88, p = 0.003 for ACEI and RR 0.8, 95% CI 0.75-0.86, p < 0.0001 for ARB). Treating 100 patients with ACEI or 50 patients with ARB prevents one case of new onset DM.
The cumulative evidence suggests that the use of ACEI/ARB prevents diabetes mellitus. This finding may be of special clinical benefit in patients with hypertension and prediabetes or metabolic syndrome.
近年来，糖尿病（DM）的患病率呈指数级增长，预计未来 15 年内将有 1 亿人患上糖尿病。医学治疗对新发糖尿病的影响尚不清楚。我们进行了系统评价和荟萃分析，以研究血管紧张素转换酶抑制剂（ACEI）和血管紧张素受体阻滞剂（ARB）对新发糖尿病的影响。
检索 MEDLINE、EMBASE、BIOSIS 和 Cochrane 数据库，时间截至 2009 年 2 月，以评估 ACEI 或 ARB 治疗新发糖尿病的随机对照试验（RCT）。共纳入 18 项 RCT 进行荟萃分析。采用随机效应模型，通过 I(2)估计各研究间的异质性。
共纳入 50451 例接受 ACEI 或 ARB 治疗的患者和 50397 例接受其他治疗的患者。ACEI/ARB 的使用与新发糖尿病的减少相关（RR 0.78，95%CI 0.70-0.88，p=0.003；RR 0.8，95%CI 0.75-0.86，p<0.0001）。治疗 100 例患者用 ACEI 或 50 例患者用 ARB 可预防 1 例新发糖尿病。
累积证据表明，ACEI/ARB 的使用可预防糖尿病。这一发现可能对高血压、糖尿病前期或代谢综合征患者具有特殊的临床益处。
