title: ACE inhibitor use is associated with hospitalization for severe hypoglycemia in patients with diabetes. DARTS/MEMO Collaboration. Diabetes Audit and Research in Tayside, Scotland. Medicines Monitoring Unit.
abstract: OBJECTIVE
  To evaluate the association between the use of ACE inhibitors and hospital admission for severe hypoglycemia and to explore the effects of potential confounding variables on this relationship.
  
  
  METHODS
  The association between the use of ACE inhibitors and the incidence of hypoglycemia is controversial. A recent study reported that 14% of all hospital admissions for hypoglycemia might be attributable to ACE inhibitors. We performed a nested case-control study, using a cohort of 6,649 diabetic patients taking insulin or oral antidiabetic drugs, on the Diabetes Audit and Research in Tayside, Scotland (DARTS) database. From 1 January 1993 to 30 April 1994, we identified 64 patients who had been admitted to Tayside hospitals with hypoglycemia and selected 440 control patients from the same cohort.
  
  
  RESULTS
  Hypoglycemia was associated with the use of ACE inhibitors (odds ratio [OR] 3.2, 95% CI 1.2-8.3, P = 0.023), whereas use of beta-blockers and calcium antagonists was not associated with an increased risk of hospitalization for hypoglycemia with ORs of 0.9 (95% CI 0.3-3.3) and 1.7 (95% CI 0.2-2.1), respectively. There were significant differences between case and control patients in type of diabetes treatment, diabetes duration, place of routine diabetes care, and congestive cardiac failure. These differences did not confound the relationship between ACE inhibitors and hypoglycemia (adjusted OR 4.3, 95% CI 1.2-16.0).
  
  
  CONCLUSIONS
  The results show that the association between ACE inhibitor therapy and hospital admission for severe hypoglycemia is not explained by these confounding factors. Although ACE inhibitors have distinct advantages over other antihypertensive drugs in diabetes, the risk of hypoglycemia should be considered.
authors.affiliation: Department of Medicine, Ninewells Hospital and Medical School, University of Dundee, Scotland, U.K. amorris@clinpharm.dundee.ac.uk
authors.forename: A D
authors.initials: AD
authors.lastname: Morris
authors.forename: D I
authors.initials: DI
authors.lastname: Boyle
authors.forename: A D
authors.initials: AD
authors.lastname: McMahon
authors.forename: H
authors.initials: H
authors.lastname: Pearce
authors.forename: J M
authors.initials: JM
authors.lastname: Evans
authors.forename: R W
authors.initials: RW
authors.lastname: Newton
authors.forename: R T
authors.initials: RT
authors.lastname: Jung
authors.forename: T M
authors.initials: TM
authors.lastname: MacDonald
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D015986:Confounding Factors, Epidemiologic; D000075202:Contraindications; D016208:Databases, Factual; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D016017:Odds Ratio; D012307:Risk Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D007004:Hypoglycemic Agents; D007328:Insulin