scholarly journals Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Severe Hypoglycemia Complicating Type 2 Diabetes: The Fremantle Diabetes Study

Endocrinology ◽  
2011 ◽  
Vol 152 (3) ◽  
pp. 1195-1195
Author(s):  
Wendy A. Davis ◽  
Simon G. A. Brown ◽  
Ian G. Jacobs ◽  
Max Bulsara ◽  
John Beilby ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitor ◽  
Severe Hypoglycemia ◽  
Community Dwelling ◽  
Inhibitor Therapy ◽  
First Episode ◽  
Converting Enzyme

Abstract Aims/Hypotheses: The aims of this study were to determine whether the angiotensin-converting enzyme (ACE) gene I/D polymorphisms independently predict severe hypoglycemia in community-dwelling type 2 patients. Methods: Six hundred two patients who were ACE genotyped at baseline and assessed in 1998 were followed up to the end of June 2006. Severe hypoglycemia was defined as that requiring documented health service use as the primary diagnosis. Cox proportional hazards modeling was used to determine the predictors of first episode and zero-inflated negative binomial regression modeling identified predictors of frequency. Results: Forty-nine patients (8.1%) experienced 63 episodes of severe hypoglycemia. After adjusting for previously identified significant independent predictors of time to first episode, both ACE DD genotype and ACE inhibitor therapy, but not their interaction, added to the model [hazard ratio (95% confidence interval): 2.34 (1.29–4.26), P = 0.006, and 1.77 (0.99–3.13), P = 0.052, respectively]. Similarly, after adjusting for previously identified risk factors for multiple episodes of severe hypoglycemia, ACE DD genotype was independently associated with increased risk [incidence relative risk (95% confidence interval): 1.80 (1.00–3.24), P = 0.050]. Conclusions/Interpretation: ACE DD genotype is associated with an increased the risk of the first episode of severe hypoglycemia and its subsequent frequency approximately 2-fold in well-characterized patients with type 2 diabetes. Consistent with previous case-control studies, ACE inhibitor therapy was a weak predictor of severe hypoglycemia. ACE I/D genotyping might provide useful adjunctive prognostic information when intensive glycemic control measures are contemplated.

scholarly journals Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Severe Hypoglycemia Complicating Type 2 Diabetes: The Fremantle Diabetes Study

2011 ◽  
Vol 96 (4) ◽  
pp. E696-E700 ◽  
Author(s):  
Wendy A. Davis ◽  
Simon G. A. Brown ◽  
Ian G. Jacobs ◽  
Max Bulsara ◽  
John Beilby ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Confidence Interval ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitor ◽  
Severe Hypoglycemia ◽  
Inhibitor Therapy ◽  
First Episode ◽  
Converting Enzyme ◽  
Increased Risk

Abstract Aims/hypotheses: The aim of this study was to determine whether the angiotensin-converting enzyme (ACE) gene I/D polymorphisms independently predict severe hypoglycemia in community-dwelling type 2 patients. Methods: Six hundred and two patients who were ACE genotyped at baseline and assessed in 1998 were followed up to the end of June 2006. Severe hypoglycemia was defined as that requiring documented health service use as the primary diagnosis. Cox proportional hazards modeling was used to determine the predictors of first episode and zero-inflated negative binomial regression modeling identified predictors of frequency. Results: Forty-nine patients (8.1%) experienced 63 episodes of severe hypoglycemia. After adjusting for previously identified significant independent predictors of time to first episode, both ACE DD genotype and ACE inhibitor therapy, but not their interaction, added to the model [hazard ratio (95% confidence interval): 2.34 (1.29–4.26), P = 0.006, and 1.77 (0.99–3.13), P = 0.052, respectively]. Similarly, after adjusting for previously identified risk factors for multiple episodes of severe hypoglycemia, ACE DD genotype was independently associated with increased risk [incidence relative risk (95% confidence interval): 1.80 (1.00–3.24), P = 0.050]. Conclusions/interpretation: ACE DD genotype was associated with an approximately 2-fold increased risk of the first episode of severe hypoglycemia and its subsequent frequency in well-characterized patients with type 2 diabetes. Consistent with previous case-control studies, ACE inhibitor therapy was a weak predictor of severe hypoglycemia. ACE I/D genotyping might provide useful adjunctive prognostic information when intensive glycemic control measures are contemplated.

scholarly journals The Impact of the Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism on Severe Hypoglycemia in Type 2 Diabetes

2006 ◽  
Vol 3 (2) ◽  
pp. 76-76 ◽  
Author(s):  
Rachel M. Freathy ◽  
Kathryn F. Lonnen ◽  
Anna M. Steele ◽  
Jayne A. L. Minton ◽  
Timothy M. Frayling ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Angiotensin Converting Enzyme ◽  
Severe Hypoglycemia ◽  
Converting Enzyme ◽  
Deletion Polymorphism ◽  
The Impact

Cost-effectiveness of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers in newly diagnosed type 2 diabetes in Germany

2010 ◽  
Vol 26 (1) ◽  
pp. 62-70 ◽  
Author(s):  
Charles Christian Adarkwah ◽  
Afschin Gandjour
Keyword(s):  
Type 2 Diabetes ◽  
Angiotensin Ii ◽  
Angiotensin Converting Enzyme ◽  
Renal Disease ◽  
Ace Inhibitor ◽  
Converting Enzyme ◽  
Newly Diagnosed ◽  
Angiotensin Ii Receptor ◽  
Progression Of Renal Disease

Objectives: Type 2 diabetes is the main cause of end-stage renal disease in Europe and the United States. Angiotensin-converting enzyme (ACE) inhibitors slow down the progression of renal disease and, therefore, provide a renal-protective effect. The aim of this study was to assess the most cost-effective time to start an ACE inhibitor (or an angiotensin II receptor blocker in the event of cough) in patients with type 2 diabetes in Germany.Methods: Three strategies were compared: treating all patients at the time of diagnosing type 2 diabetes, screening for microalbuminuria, and screening for macroalbuminuria. A lifetime Markov decision model with simulated 50-year-old patients with newly diagnosed diabetes mellitus was developed using published data on costs and health outcomes and simulating the progression of renal disease. A statutory health insurance perspective was adopted.Results: In the base-case analysis, the treat-all strategy is associated with the lowest costs and highest benefit and, therefore, dominates screening both for macroalbuminuria and microalbuminuria. A multivariate sensitivity analysis shows that the probability of savings is 89 percent.Conclusions: Patients with type 2 diabetes should receive an ACE inhibitor immediately after diagnosis if they do not have contraindications. The potential for cost savings would be even larger if the prevention of cardiovascular events were considered.

Pharmacoeconomic Analysis of Angiotensin-Converting Enzyme Inhibitors in Type 2 Diabetes: A Markov Model

2007 ◽  
Vol 41 (7-8) ◽  
pp. 1101-1110 ◽  
Author(s):  
Heather M Campbell ◽  
Kathy D Boardman ◽  
Melanie A Dodd ◽  
Dennis W Raisch
Keyword(s):  
Type 2 Diabetes ◽  
Angiotensin Converting Enzyme ◽  
Markov Model ◽  
Ace Inhibitor ◽  
Pharmacoeconomic Analysis ◽  
Composite Endpoint ◽  
Sensitivity Analyses ◽  
Converting Enzyme ◽  
Newly Diagnosed

Background: Prevention of cardiovascular disease (CVD) events by initiating an angiotensin-converting enzyme (ACE) inhibitor on diagnosis of type 2 diabetes may increase survival and decrease costs. Objective: To determine the incremental cost-effectiveness ratios of ACE inhibitor initiation in normoaIbuminuric, microalbuminuruc, and macroaIbuminuric patients with newly diagnosed type 2 diabetes. Methods: A cohort of patients with newly diagnosed type 2 diabetes was followed for 8 years in a Markov model. Clinical outcomes included CVD events, dialysis, all-cause mortality, and the composite endpoints of the 3 events. Probabilities and costs were obtained from the literature. One-way and two-way sensitivity analyses were conducted to test the robustness of the model. Results: Implementation of ACE inhibitor therapy on diagnosis of type 2 diabetes in normoalbuminuric and microalbuminuric patients is a dominant strategy (ie, more effective and less costly) across all outcomes. In macro-albuminuric patients, an additional $4,10 and $4.58 saves one life and avoids one composite endpoint, respectively; however, in these patients, not giving an ACE inhibitor is dominant for prevention of CVD events and dialysis. This is due to a 28.62% higher mortality rate in patients not receiving an ACE inhibitor. Thus, analysts of the composite endpoint shows that not giving an ACE inhibitor does not remain dominant. A limitation of our study is the inability to determine causality. Conclusions: If every newly diagnosed patient with type 2 diabetes in the US was prescribed an ACE inhibitor, our model shows that 68 314 CVD events would be averted, 46410 lives would be saved, and 48 people would be prevented from needing dialysis over 8 years. These findings suggest that ACE inhibitors prevent numerous events in patients with type 2 diabetes who are normoalbuminuric at diagnosis, in addition to those already identified as being at risk for CVD events.

DD genotype of angiotensin-converting enzyme in type 2 diabetes mellitus with renal disease in Mexican Mestizos

Nephrology ◽  
2009 ◽  
Vol 14 (2) ◽  
pp. 235-239 ◽  
Author(s):  
SILVIA PALOMO-PIÑÓN ◽  
MARGARITA E GUTIÉRREZ-RODRÍGUEZ ◽  
MARGARITA DÍAZ-FLORES ◽  
REYNA SÁNCHEZ-BARRERA ◽  
ADÁN VALLADARES-SALGADO ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Angiotensin Converting Enzyme ◽  
Renal Disease ◽  
Converting Enzyme ◽  
Mexican Mestizos

Angiotensin-Converting Enzyme Gene Polymorphism and Erythropoietin Requirement

2003 ◽  
Vol 23 (2) ◽  
pp. 111-115 ◽  
Author(s):  
Mira Varagunam ◽  
Daniel J. McCloskey ◽  
Paul J. Sinnott ◽  
Martin J. Raftery ◽  
Muhammed M. Yaqoob
Keyword(s):  
Renal Failure ◽  
Parathyroid Hormone ◽  
Angiotensin Converting Enzyme ◽  
Ace Inhibitor ◽  
Inhibitor Therapy ◽  
Converting Enzyme ◽  
C Reactive Protein ◽  
Dose Requirement ◽  
Reactive Protein ◽  
Significant Difference

Objectives To study the effect of angiotensin-converting enzyme (ACE) polymorphisms II, ID, and DD on erythropoietin (EPO) requirement in patients on continuous ambulatory peritoneal dialysis (CAPD) therapy. Design Retrospective observational study. Setting CAPD Unit, Royal London/St. Bartholomews Hospital, London, UK. Patients 46 patients on the transplant waiting list (age 20 – 70 years), on CAPD therapy for an average of 28 months, seen consecutively over a period of 3 months in the outpatients department. Main Outcome Measures Primary end point: EPO dose requirement in different ACE genotypes. Secondary end points: C-reactive protein, ferritin, parathyroid hormone, Kt/V, duration of dialysis, folate, cause of renal failure, and whether or not patients were on ACE inhibitor therapy. Results There was a statistically significant difference ( p < 0.05) in EPO requirement in the II/ID group compared to the DD group. The mean ± standard error of EPO for the II/ID group was 144 ± 15 U/kg/week, and for the DD group, 87 ± 9 U/kg/ week. The difference in EPO requirement could not be explained by age, C-reactive protein, ferritin, parathyroid hormone, Kt/V, duration of dialysis, folate, cause of renal failure, or whether or not patients were on ACE inhibitor therapy. Conclusion In CAPD patients, ACE genotype has predictive value when determining the EPO dosage, as the II/ID genotype may be associated with a suboptimal response.

scholarly journals METFORMIN USE IN DIABETES PRIOR TO HOSPITALIZATION: EFFECTS ON MORTALITY IN COVID-19

2020 ◽  
Vol 26 (10) ◽  
pp. 1166-1172
Author(s):  
Jinghong Li ◽  
Qi Wei ◽  
Willis X. Li ◽  
Karen C. McCowen ◽  
Wei Xiong ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Severe Acute Respiratory Syndrome ◽  
Angiotensin Converting Enzyme ◽  
Clinical Data ◽  
Laboratory Data ◽  
Converting Enzyme ◽  
Angiotensin Converting Enzyme 2

Objective: Although type 2 diabetes mellitus (T2DM) has been reported as a risk factor for coronavirus disease 2019 (COVID-19), the effect of pharmacologic agents used to treat T2DM, such as metformin, on COVID-19 outcomes remains unclear. Metformin increases the expression of angiotensin converting enzyme 2, a known receptor for severe acute respiratory syndrome coronavirus 2. Data from people with T2DM hospitalized for COVID-19 were used to test the hypothesis that metformin use is associated with improved survival in this population. Methods: Retrospective analyses were performed on de-identified clinical data from a major hospital in Wuhan, China, that included patients with T2DM hospitalized for COVID-19 during the recent epidemic. One hundred and thirty-one patients diagnosed with COVID-19 and T2DM were used in this study. The primary outcome was mortality. Demographic, clinical characteristics, laboratory data, diabetes medications, and respiratory therapy data were also included in the analysis. Results: Of these 131 patients, 37 used metformin with or without other antidiabetes medications. Among the 37 metformin-taking patients, 35 (94.6%) survived and 2 (5.4%) did not survive. The mortality rates in the metformin-taking group versus the non-metformin group were 5.4% (2/37) versus 22.3% (21/94). Using multivariate analysis, metformin was found to be an independent predictor of survival in this cohort ( P = .02). Conclusion: This study reveals a significant association between metformin use and survival in people with T2DM diagnosed with COVID-19. These clinical data are consistent with potential benefits of the use of metformin for COVID-19 patients with T2DM. Abbreviations: ACE2 = angiotensin-converting enzyme 2; AMPK = AMP-activated protein kinase; BMI = body mass index; COVID-19 = coronavirus disease 2019; SARSCoV-2 = severe acute respiratory syndrome coronavirus 2; T2DM = type 2 diabetes mellitus

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