The renin–angiotensin–aldosterone system: a pivotal role in insulin sensitivity and glycemic control
- 1 April 2008
- journal article
- review article
- Published by Ovid Technologies (Wolters Kluwer Health) in Current Opinion in Endocrinology, Diabetes and Obesity
- Vol. 15 (2), 147-152
- https://doi.org/10.1097/med.0b013e3282f7026f
Abstract
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 angiotensin II receptor blockers leads to improved insulin sensitivity, glycemic control and possibly prevention of type 2 diabetes mellitus. Several major studies investigating angiotensin 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, beta-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. 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.Keywords
This publication has 40 references indexed in Scilit:
- Mechanisms of protective effects induced by blockade of the renin-angiotensin system: novel role of the pancreatic islet angiotensin-generating system in Type 2 diabetesDiabetic Medicine, 2007
- Effect of Ramipril on the Incidence of DiabetesThe New England Journal of Medicine, 2006
- Angiotensin II Type 1 Receptor Blockade Improves β-Cell Function and Glucose Tolerance in a Mouse Model of Type 2 DiabetesDiabetes, 2006
- Rationale, design, and baseline characteristics of 2 large, simple, randomized trials evaluating telmisartan, ramipril, and their combination in high-risk patients: the Ongoing Telmisartan Alone and in Combination with Ramipril Global Endpoint Trial/Telmisartan Randomized Assessment Study in ACE Intolerant Subjects with Cardiovascular Disease (ONTARGET/TRANSCEND) trialsAmerican Heart Journal, 2004
- Identification of Telmisartan as a Unique Angiotensin II Receptor Antagonist With Selective PPARγ–Modulating ActivityHypertension, 2004
- Blockade of the Renin-Angiotensin System Increases Adiponectin Concentrations in Patients With Essential HypertensionHypertension, 2003
- Major Outcomes in High-Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic: The Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT)Jama-Journal Of The American Medical Association, 2002
- Effects of Angiotensin II on Adipose Conversion and Expression of Genes of the Renin-Angiotensin System in Human PreadipocytesHormone and Metabolic Research, 2001
- Insulin sensitivity and the effects of insulin on renal sodium handling and pressor systems in essential hypertensive patients.Hypertension, 1994
- Diabetes and cardiovascular disease. The Framingham studyJAMA, 1979