Possible Beneficial Effect of Telmisartan on Glycemic Control in Diabetic Subjects

Abstract

Peripheral Arterial Compliance Differs Between Races Comparison among Asian, Afro-Caribbeans, and white Caucasians with type 2 diabetes P atients with type 2 diabetes have two to three times the risk of dying prematurely from cardiovascular disease than their nondiabetic counterparts (1). Many studies have shown that arterial compliance is reduced in type 2 diabetes and that arterial stiffness increases with deteriorating glucose tolerance status, even before the onset of type 2 diabetes (2-4). In a previous brief report, we studied Afro-Caribbean and white Caucasian subjects with diabetes and found a decrease in peripheral arterial compliance in the Afro-Caribbean subjects (5). We also reported an accelerated rate of aging in the elastic arteries of diabetic patients reaching a plateau by the age of 50-60 years (6). The present article examines the control versus diabetic differences in two races, white Caucasians and Afro-Caribbeans, and includes data on Asians from the Indian subcontinent with diabetes. Fifty-seven patients with a diagnosis of type 2 diabetes for at least 1 year (21 white Caucasian, 20 Afro-Caribbean, and 16 Asian) aged 44-80 years (mean Ϯ SD 61 Ϯ 7.4) and 48 healthy control subjects (30 white Caucasian and 18 Afro-Caribbean) aged 34-86 years (65.5 Ϯ 11.6) took part in this cross-sectional study. Pulse wave velocity of the carotidfemoral (PWV cf) was measured noninvasively in a thoraco-abdominal segment and in an upper-limb muscular artery (PWV of the carotid-radial [PWV cr ]) using the Complior (Colson, Pantin, France) system. PWV from the aorta to the finger (PWV fin) was measured using the Finapress (Ohmeda, Madison, WI) and custom-written software (J.D.C.). Central aortic compliance (CAC) was also assessed from simultaneous measurements of ascending aortic blood flow and surrogate estimates of aortic root pressure using a method described by Liu et al. (7) and previously reported by Cameron et al. (8). Analysis of the clinical characteristics of the participants for the diabetic and control groups and by ethnicity showed that for the diabetic group, only BMI was significantly different between the races (P Ͻ 0.05), with the white patient group having the highest mean value (29.9 kg/ m 2). For the control population, only age was significantly different (P ϭ 0.01), with Caucasians being on average 8 years older than Afro-Caribbeans. Race was found to be a major determinant of PWV cr in type 2 diabetic subjects, with Afro-Caribbeans having the highest mean value (12.10 Ϯ 1.4 m/s) of the three ethnic origins (P ϭ 0.03) compared with Caucasians (11.12 Ϯ 1.3 m/s) and Asians (10.95 Ϯ 1.3 m/s). The racial differences were independent of blood pressure. No differences were found between the races for PWV cf , PWV fin , or CAC. Analysis in the control population showed no differences in arterial compliance between the Afro-Caribbeans and Caucasians. We have shown that there is a racial preponderance of stiffening of the peripheral arteries in diabetic subjects, with subjects of Afro-Caribbean origi...

Improvement of endothelial function in patients with hypertension and type 2 diabetes after treatment with telmisartan

“…Telmisartan, in addition to its blood pressure-lowering effect, has been reported to exert its antiatherogenic effect by blocking angiotensin II-induced oxidative stress and inflammation in cardiovascular tissues. 3,9,21 Furthermore, telmisartan has been reported to have an antidiabetic effect, [14][15][16][17] possibly by improving insulin sensitivity. Telmisartan, a unique ARB, has proven to be a partial PPARg agonist because of its structural similarity to thiazolidinedione derivatives, thereby improving insulin sensitivity and reducing inflammation.…”

“…[10][11][12][13] In hypertensive patients associated with T2DM and/or the metabolic syndrome, several clinical studies have shown that telmisartan has beneficial effects on glucose and lipid metabolism in addition to its antihypertensive effect. [14][15][16][17] Thus, cardiovascular protective effects of telmisartan in hypertensive patients with T2DM could be due to the combined actions of its potent blockade in the renin-angiotensin system and its partial activation of PPARg.…”

The Effects of Telmisartan and Losartan on Insulin Sensitivity

“…In both groups, there were no difference between blood pressure, fasting plasma glucose, basal insulin levels, HOMA-IR values and adiponectin levels. In several experimental and clinical studies, telmisartan and losartan have been shown to increase insulin sensitivity, reduce the occurrence of diabetes and lower fasting plasma glucose and HbA1c levels in diabetic patients (18,22,23,24,25). These two ARBs' beneficial effects on insulin resistance and glucose metabolism are due to their RAS blockade ability.…”

The Insulin Sparing Effect of Telmisartan in a Case of Type 2 Diabetes Mellitus Associated with Schizophrenia under Treatment of Risperidone

“…1 We first review studies in the clinical situation. There has been increasing evidence that suggests improvement in glycemic control (1,2,8,9) and favorable effects on lipid profile including reduction of LDL-cholesterol (9,10) by telmisartan administration. Quite recently, Makita et al (11) showed that telmisartan rather than candesartan may have a larger impact on obesity-related disease, demonstrating that telmisartan decreases fasting blood glucose and body weight.…”