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The renin–angiotensin–aldosterone system: a pivotal role in insulin sensitivity and glycemic control

Perkins, Jennifer M; Davis, Stephen N

Current Opinion in Endocrinology, Diabetes and Obesity: April 2008 - Volume 15 - Issue 2 - p 147–152
doi: 10.1097/MED.0b013e3282f7026f
Diabetes and the endocrine pancreas: Edited by Allison B. Goldfine
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Purpose of review Diabetes mellitus is an exploding epidemic costing billions of dollars yearly. Type 2 diabetes mellitus is characterized by insulin resistance and is closely associated with arterial hypertension. Emerging literature has demonstrated that modulation of the renin–angiotensin–aldosterone system by use of angiotensin-converting enzyme inhibitors or angiotensn II receptor blockers leads to improved insulin sensitivity, glycemic control and possibly prevention of type 2 diabetes mellitus.

Recent findings Several major studies investigating angiotensn II receptor blocker or angiotensin-converting enzyme inhibitor use in either hypertensive or heart failure patients have found lower incidence of type 2 diabetes mellitus when compared with placebo, β-blocker, calcium-channel blocker or diuretic. None of these trials, however, studied prevention of diabetes as a primary endpoint. The Dream Trial and upcoming NAVIGATOR, ONTARGET/TRANSCEND trials specifically look at the prevention of diabetes as a primary endpoint. Several studies have evaluated possible mechanisms of how the renin–angiotensin–aldosterone system can alter insulin sensitivity and glycemic control.

Summary This review will focus on the recent literature that demonstrates renin–angiotensin–aldosterone system modulation and its effects on diabetes prevention, glycemic control and insulin sensitivity, as well as possible mechanisms for achieving this goal.

Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University, Nashville, Tennesse, USA

Correspondence to Stephen N. Davis, MD, FRCP Chief, Division of Diabetes, Endocrinology and Metabolism, Mark Collie Professor of Medicine, Molecular Physiology and Biophysics, Vanderbilt University, 7465 MRB IV, Nashville, TN 37232-0475, USA Tel: +1 615 936 1649; fax: +1 615 936 1250; e-mail: Steve.davis@vanderbilt.edu

© 2008 Lippincott Williams & Wilkins, Inc.