Herings R M, de Boer A, Stricker B H, Leufkens H G, Porsius A
Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Netherlands.
Lancet. 1995 May 13;345(8959):1195-8. doi: 10.1016/s0140-6736(95)91988-0.
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% CI 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.
血管紧张素转换酶（ACE）抑制剂的使用与糖尿病患者胰岛素敏感性增加有关。尽管这种作用可能对糖尿病患者的高血压或充血性心力衰竭治疗有益，但它也可能引发严重低血糖。为了验证这一假设，我们利用荷兰PHARMO系统（1986 - 92年）的数据，对接受胰岛素或口服降糖药治疗且因低血糖住院的糖尿病患者进行了一项巢式病例对照研究。我们确定了94例因低血糖住院的患者，并从同一队列中选择了654例对照。在对一系列潜在混杂因素进行调整后，低血糖与当前使用ACE抑制剂显著相关（比值比2.8 [95%可信区间1.4 - 5.7]）。在胰岛素使用者和口服降糖药使用者中，使用ACE抑制剂均与因低血糖住院的风险增加显著相关（分别为2.8 [1.2 - 6.4]和4.1 [1.4 - 12.2]）。尽管ACE抑制剂在糖尿病治疗中比其他降压药有几个优势，但低血糖风险应予以考虑。由于所有低血糖住院病例中多达13.8%可能归因于ACE抑制剂的使用，因此需要对其机制进行进一步研究。
