Telmisartan does not improve glucose levels in high-risk patients
MedWire News: Addition of the angiotensin receptor blocker (ARB) telmisartan to usual care does not prevent incident diabetes in people at high risk for cardiovascular disease or diabetes, research shows.
Telmisartan also failed to induce regression of impaired fasting glucose (IFG) or impaired glucose tolerance (IGT).
As reported in the journal Diabetes Care, Joshua Barzilay (Emory University, Georgia, USA) and team examined data from the Telmisartan Randomized Assessment Study in ACE Intolerant Subjects With Cardiovascular Disease (TRANSCEND).
Telmisartan is of particular interest because it is believed to be more effective than other ARBs in ameliorating glucose metabolism and insulin resistance, explain the authors.
The researchers investigated 3488 nondiabetic TRANSCEND participants (mean age 67 years) who had been randomly assigned to either the ARB telmisartan (80 mg per day) or placebo and followed-up for a median of 56 months.
The authors found that there was no significant difference in incident diabetes between the telmisartan patients (21.8%) and those given placebo (22.4%) by the end of follow-up.
There was also no significant difference in the proportion of participants with IFG and/or IGT who regressed to normal glucose status on telmisartan (26.9%) compared with placebo (24.5%). Likewise, a similar proportion progressed to incident diabetes in the telmisartan and placebo groups (20.1 vs 21.1%, respectively).
The findings contrast with those of the Nateglinide and Valsartan in Impaired Glucose Tolerance Outcomes Research (NAVIGATOR) trial, which reported a lower incident diabetes rate with ARB treatment in patients with cardiovascular disease.
ARBs are believed to be insulin sensitizing through their effects on muscle, microcirculation, and pancreatic β-cells, Barzilay and team write.
In addition, telmisartan is believed to activate peroxisome proliferator-activated receptor-γ, a nuclear receptor regulator of carbohydrate metabolism.
However, "despite these potential advantages, there was no statistically significant impact of telmisartan on glucose disorders found in this study," the team concludes.
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By Sally Robertson