ACE inhibitors and hypoglycaemia

The relationship between ACE genotype and risk of severe hypoglycaemia in a large population-based cohort of children and adolescents with type 1 diabetes

“…Some evidence has been presented to suggest that predisposition to severe hypoglycaemia may also have some genetic basis. Herings et al [9] and Morris et al [10] have shown that the use of ACE inhibitors increased the risk of having a severe hypoglycaemic event in adults, but these studies were retrospective in design and the findings remain controversial [11][12][13][14]. The fact that a small proportion of patients experiences severe hypoglycaemia whereas other patients with similar glycaemic control remain spared indicates that genetic factors may contribute to an increased risk, and studies conducted in Denmark and Sweden have supported this notion [8,20,21].…”

“…It has been suggested that genetic factors may predispose to a susceptibility to severe hypoglycaemia. Studies have shown that the use of ACE inhibitors may be a factor in the incidence of hypoglycaemia in adults [9,10], but this still remains controversial [11][12][13][14], as these studies were retrospective in design and were unable to adjust for some important confounding variables.…”

ACE Inhibitor Use Is Associated With Hospitalization for Severe Hypoglycemia in Patients With Diabetes

“…It was argued that these factors DIABETES CARE, VOLUME 20, NUMBER 9, SEPTEMBER 1997 explain the apparent association between ACE inhibitors and severe hypoglycemia by confounding by indication (8). Thus ACE inhibitors are often prescribed preferentially to diabetic patients with heart failure and to hypertensive, microalbuminuric (or macroalbuminuria) diabetic patients with renal impairment (15,16) to slow disease progression.…”

“…Perhaps the most controversial study that has evaluated this relationship is the recent report by Herings et al (7), which concluded that as many as 14% of hospital admissions for hypoglycemia might be attributable to the use of ACE inhibitors. Other authors (8)(9)(10) urged caution when interpreting these results because the nested case-control study design made no adjustment for potential confounders such as renal function, heart failure, or coexistent cardiovascular disease. Because ACE inhibitors may be preferentially given to these patients who are already at increased risk of hypoglycemia, the study may have been subject to a form of bias known as "confounding by indication."…”

Hypoglycemia Associated with the Administration of Angiotensin-Converting Enzyme Inhibitor in a Patient with Diabetes Mellitus.

“…In the present case, it is possible that impaired renal function exaggerated hypoglycemic action of the angiotensin-converting enzymeinhibitor. Whatever the mechanisms, we should be aware of the possibility of hypoglycemia with angiotensin-converting enzymeinhibitors in Japanese patients as well as Caucasian patients, especially in those associated with diabetic nephropathy (8).…”