Department of Diabetes and Metabolic Medicine, Center Hospital, National Center for Global Health and Medicine, Tokyo, Japan ; Department of Diabetes Research, Diabetes Research Center, Research Institute, National Center for Global Health and Medicine, Tokyo, Japan.
Diabetes Metab Syndr Obes. 2013 Jul 26;6:257-61. doi: 10.2147/DMSO.S49767. Print 2013.
Insulin resistance and the progressive loss of β-cell function are components of the fundamental pathophysiology of type II diabetes. A recent experimental study suggested that calcium channel blockers (CCBs) might inhibit β-cell apoptosis, enhance β-cell function, and prevent diabetes. The present meta-analysis examined the clinical effect of CCBs on the incidence of diabetes.
MEDLINE, EMBASE, ISI Web of Science, the Cochrane Library, and ClinicalTrials. gov were each searched for relevant articles published up to March 11, 2013. Randomized controlled trials (RCTs) with a follow-up period of at least 1-year were included. Identified articles were systematically reviewed, and those with pertinent data were selected for inclusion in a meta-analysis.
We included ten RCTs in a meta-analysis. Of the 108,118 people with hypertension and no pre-existing diabetes, 7,073 (6.5%) cases of type II diabetes were reported. CCBs were associated with a higher incidence of diabetes than angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin-receptor blockers (ARBs; pooled risk ratios [95% confidence intervals]: 1.23 [1.01-1.51] and 1.27 [1.14-1.42], respectively) and a lower incidence compared with β blockers or diuretics (0.83 [0.73-0.94] and 0.82 [0.69-0.98], respectively). The overall risk of diabetes among subjects taking CCBs was not significant (0.99 [0.85-1.15]).
THE USE OF CCBS WAS NOT SIGNIFICANTLY ASSOCIATED WITH INCIDENT DIABETES COMPARED TO OTHER ANTIHYPERTENSIVE AGENTS: the association with diabetes was lowest for ACEIs and ARBs, followed by CCBs, β blockers, and diuretics. Although CCBs can be safely used in hypertensive patients, it would be premature to advocate CCBs for the prevention or treatment of diabetes.
胰岛素抵抗和β细胞功能的进行性丧失是 2 型糖尿病基本病理生理学的组成部分。最近的一项实验研究表明，钙通道阻滞剂（CCB）可能抑制β细胞凋亡，增强β细胞功能，并预防糖尿病。本荟萃分析检查了 CCB 对糖尿病发病率的临床影响。
对截至 2013 年 3 月 11 日的 MEDLINE、EMBASE、ISI Web of Science、Cochrane 图书馆和 ClinicalTrials.gov 进行了搜索，以查找相关的已发表文章。纳入了随访时间至少 1 年的随机对照试验（RCT）。对确定的文章进行了系统评价，并选择了具有相关数据的文章进行荟萃分析。
我们将 10 项 RCT 纳入荟萃分析。在 108118 名患有高血压且无既往糖尿病的患者中，报告了 7073 例（6.5%）2 型糖尿病病例。与血管紧张素转换酶抑制剂（ACEI）或血管紧张素受体阻滞剂（ARB）相比，CCB 与更高的糖尿病发病率相关（汇总风险比[95%置信区间]：1.23[1.01-1.51]和 1.27[1.14-1.42]），与β受体阻滞剂或利尿剂相比，发病率较低（0.83[0.73-0.94]和 0.82[0.69-0.98]）。服用 CCB 的受试者发生糖尿病的总体风险无显著差异（0.99[0.85-1.15]）。
与其他降压药物相比，CCB 的使用与新发糖尿病无显著相关性：与 ACEI 和 ARB 相比，与糖尿病的相关性最低，其次是 CCB、β受体阻滞剂和利尿剂。虽然 CCB 可安全用于高血压患者，但提倡 CCB 预防或治疗糖尿病还为时过早。
